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THE OLD HOSPITAL 

AND OTHER PAPERS, 

D^B: ST. JOHN ROOSA, M.D., LL.D. 



SECOND REVISED AND ENLARGED EDITION 

OF 

" A DOCTOR'S SUGGESTIONS." 



*' I speak as my understanding instrticts me^ and as mine honesty puts it 
to utterance.'''' — Winter's Tale. 



NEW YORK 
WILLIAM WOOD & COMPANY 

56 & 58 Lafayette Place 
1889 




-A^': 



«T 



ADVERTISEMENT TO THE SECOND EDI- 
TION. 

In this edition, I have taken the liberty to change 
the title of my book, because it has seemed to some 
whose judgment I value, that the present name will 
more appropriately express the character of the vol- 
ume than did "A Doctor's Suggestions " under which 
title the first edition was published. It will also be 
seen that three essays have been added to those to be 
found in the first edition. 



PREFACE 



From time to time in the course of his profes- 
sional life, the author of the following pages beside 
his regular professional work has had occasion to 
write upon subjects not technical, but of interest 
to the community at large. The papers and ad- 
dresses in which these subjects are discussed, with 
a few exceptions have been published in an isolated 
form and have been more or less widely circulated. 
Some of them have even had a large audience, but 
others have reached only those for whom they were 
originally prepared. Occasional and continued in- 
quiries for certain of these articles have induced 
the author to venture upon the publication of all 
of them in a volume. 

The central idea of the papers is an attempt to 
define and adjust the relations of the medical pro- 
fession to the community which it serves. It is 
hoped however that this idea is not so prominent 
as to prevent the papers from being of some in- 
terest to all educated people, even if they do not 



PREFACE. 

feel themselves particularly concerned in the main 
topic. Indeed the writer will have attained at least 
a part of his purpose in issuing this little book, if 
he shall succeed in securing readers who have 
hitherto believed that a doctor's point of view of 
affairs in general is necessarily a narrow one. It is 
true that our chief functions are to avert disease, 
and when this is impossible, to administer drugs 
and use the knife, but we are still men and breth- 
ren equally interested with our fellows of other call- 
ings in all that concerns the welfare of the com- 
munity at large. 

New York, August, 1880. 



CONTENTS. 

PAGE 
I. 

The Old Hospital, i 

11. 
Anniversary Address, ..... 29 

III. 
The Coming Medical Man, .... 65 

IV. 
Human Eyes, 105 

V. 

Maintenance ot Health. I., . . . .129 

VI. 

Maintenance of Health. II., .... 149 

VII. 

The Relations of the Medical Profession to 

THE State, . . . . . . . 171 

VIII. 
How should our Hospitals be Governed? . 215 

IX. 
Medical New York — Old and New, . . 237 

X. 
James Lawrence Little, M.D., . . . 257 

XI. 

The Means of Effecting the Unity of the 

Medical Profession, 287 



THE OLD HOSPITAL 

AND OTHER PAPERS. 



THE OLD HOSPITAL. 

T^HAT most veracious of chroniclers, Diedrich 
-*- Knickerbocker, is said to have written his fa- 
mous History of New York in a room of the In- 
dependent Columbian Hotel, " which commanded a 
very pleasant view of the new grounds on the Col- 
lect, together with the rear of the Poor House and 
Bridewell and a full front of the Hospital, so that 
it was the cheerfullest room in the whole house." 
The Poor House is gone, the Bridewell is gone, 
and now, alas ! the old Hospital is gone. With 
what emotions, if New Yorkers have any emotions, 
must our old citizens have seen the sight which I 
saw to-day ! What once was green sward, studded 
with trees, whose leaves have withered and opened 
for a hundred years, is now excavated earth, and 
at the hands of delving Milesians the ivj^-entwined 
front of the New York Hospital is fast being de- 
molished, and before these pages reach my readers,"^ 
there will scarce a trace be left of the venerable pile. 

* Written in i36g. 



2 THE OLD HOSPITAL. 

Let us go back, and, while we may, tell the 
story of this land-mark of old New York. What 
we are about to write may sound like a lament, 
and so we would have it ; for we believe that this 
hospital of such glorious memory for its rehef af- 
forded to the sufferings of humanity, has been 
needlessly sacrificed to the VandaHzing spirit of 
new New York. Were it the Emperor of Erie, 
Mr. James Fisk, Jr., or men of his ilk, who had 
razed these foundations, we perhaps should have 
felt no surprise ; but when we consider that those 
who have done this are the governors of the insti- 
tution, men of historic name in New York, we 
cannot but be amazed at the deed of desecration, 
which we see committed at their command. It is 
said, and it is undoubtedly true, that the hospital 
did not support itself. But what reasonable man 
expects a hospital to be self supporting? When it 
is, it is no longer an hospital, but a boarding house, 
where medical attendance is included in the bill. 
Shall we build an hospital for the reception of well- 
to-do tradesmen, who find it a little inconvenient to 
be ill at home, and for bachelor millionaires who 
have no home? Shall we place it among the private 
residences of the city, or in the green fields of West- 
chester, so that an injured patient may die before he 
reaches a ward ? 



THE OLD HOSPITAL. 3 

It cannot be denied that the location of the old 
hospital, or of the City Hospital, as it was very 
often called, was one of the very best that could 
be found for the purposes for which it was in- 
tended. 

In close proximity to the wharves and piers, 
where the mighty encrines of commerce are con- 
stantly crushing so many in their revolutions, in 
the very heart of lower Broadway, with its count- 
less sources of accidents, in fact very accessible to 
the places where half the casualties and the crimes 
of the metropolis occur, could it have remained 
where it was, it would have been for the next 
hundred years, as it has been for the last, a true 
place of succor, or when it must be, of calm death 
for the suffering poor. 

If the money for the support of this time-hon- 
ored and successful charity were not forthcoming 
by ordinary means, such as appeals to the State 
and City Legislatures, extraordinary ones should 
have been adopted. Whatever may be the faults 
of New Yorkers, want of liberality certainly cannot 
be said to be among them. We have carefully 
read the two especial reports which the governors 
have caused to be printed in regard to the re- 
moval, and we fail to find in them either any evi- 
dence of its necessity, or any proof that any vigor- 
ous steps were ever taken to obviate any supposed 



4 THE OLD HOSPITAL, 

need of this kind. The policy of the governors 
seems to have been a drifting one or, Micawber-like, 
until at last it has culminated in this tearing-down 
process, which was undoubtedly a great surprise to 
those who vainly imagined that the Hospital had 
grown into one of the best possible locations for its 
needs. 

When the city of Paris removes the Hotel DieUy 
for reasons that do not at all apply to our mag- 
nificent old hospital, surrounded as it was by green 
grass on every side, a new one is erected in the 
very centre of the city on a beautiful island, and 
on land most valuable for other purposes ; but the 
governors of the New York Hospital tear their 
buildings down, to allow the Board of Charities and 
Correction to replace it by a receiving ward, which 
will be the only hospital in the lower and middle 
part of the city. But we cannot dwell longer on 
this theme, and we must leave the subject of the 
removal, or rather of the annihilation of the New 
York Hospital, with the final remark that many be 
lieve that it was unnecessary, and more than that 
cruel to those who have a right to expect that the 
civilization which demands the sacrifice of health 
and limb, yea, even of life in its service, will furnish 
an asylum in the place where it is needed, for the 
amelioration of their woes. But, old building, hail ! 
and farewell ! and now for thy epitaph. 



THE OLD HOSPITAL. 5 

The charter of the New York Hospital was 
granted in 1770, when ''George III., by the grace 
of God, of Great Britain, France and Ireland, King, 
Defender of the Faith," sent "greeting to his lov- 
ing subjects, Peter Middleton, Samuel Bard, and 
John Jones, physicians, by their humble petition 
presented unto our trusty and well-beloved Cad- 
wallader Golden, Esq., Lieutenant-Governor," and 
granted a charter for "the society of the Hos- 
pital in the city of New York, in America." 
Among the names to whom this trust was con- 
veyed, besides the officials of the city, are many 
that are still familiar and dear to New York. 
How Knickerbocker-like they sound ! Watts, De 
Lancey, Livingston, Duane, Lispenard, Bayard, 
Rutherford, Golden, Van Cortlandt, Morris, Bogert, 
Clarkson, Beekman, Provoost, Duryea, Stuyvesant, 
Verplanck, Roosevelt, De Peyster, Rutgers, Le Roy, 
DuBois, and Buchanan. These were the honored 
men of New York, who just about one hundred 
years ago undertook the work of founding the New 
York Hospital. What a pity that the present 
governors did not wait at least till the cycle was 
complete, before beginning their work of destruc- 
tion ! A proper poetic sense, would have con- 
strained them to wait another year, when they 
might have celebrated the centenary by putting the 
axe to those old trees, planted by their forefathers 



O THE OLD HOSPITAL. 

in the vain hope that they might be left until the 
Father of Nature should cause them to die. 

The twenty-six governors held their first meeting 
on the 28th of July, 1771. Considerable contri- 
butions were made through the exertions of Dr. 
John Fothergill and Sir William Johnson, eminent 
physicians in London, by many of the inhabitants 
of that city, and other places in Great Britain, 
and in 1772, the Legislature granted an annual 
allowance of eight hundred pounds. In 1773 five 
acres of ground were purchased of Mrs. Barclay 
and Mr. Rutgers, and the foundations were laid 
on the 27th of July of the same year. On Feb- 
ruary 28, 1775, when the building was almost 
completed, it was nearly consumed by fire. The 
war of Independence prevented the completion of 
the edifice, but it was used during the war for bar- 
racks, and occasionally as an hospital. It was not 
until January 3, 1791, that the house was in a 
proper condition to receive patients. It is at this 
point that the real existence of the hospital, 
begins. The building thus erected was the one 
fronting the main entrance on Broadway. Some 
additions and improvements were made in it, how- 
e.ver, from time to time. It was known as the 
Main Building. In it were the apothecary's shop, 
the office, the dining-rooms, and the governors' 
rooms, where met the various committees. In its 



THE OLD HOSPITAL. 7 

amphitheatre were achieved the surgical triumphs 
of Wright Post, Kearney Rodgers, Valentine Mott, 
and Alexander H. Stevens, names which have made 
the surgery of our country respected throughout 
the world. The south building on Duane street 
was erected in 1853, replacing one that was erected 
in 1806. This noble building was in many respects 
a model of hospital architecture. The north build- 
ing on Worth street was erected in 1841. The 
main and north hospitals are now torn down, while 
the south is to be left cooped up by a sohd block 
of ware-houses, with noisy streets on every side. 
It certainly will not be an hospital when thus 
situated. House of Alarms would be a more ap- 
propriate name. 

We cannot imagine why all the buildings were 
not torn down at once. " If it were done when 'tis 
done, then 'twere well it were done quickly." 

It should be stated that the Bloomingdale 
Hospital for the Insane on the borders of the 
Central Park, is also part and parcel of the 
Society of the New York Hospital. It does not, 
however, fall within the scope of this paper to 
give any more than this passing notice of that 
excellent asylum. 

Since 1829, more than one hundred thousand 
patients have been treated in this hospital, of whom 
more than seventy thousand have been cured, 



b THE OLD HOSPITAL. 

while ten thousand have died. More than nine 
thousand were reh'eved. The remainder were dis- 
charged at their own request, or eloped. There 
are no published records prior to 1829. In the 
year 1868, two hundred more patients were treated 
than in 1867. 

There is a valuable library of more than eight 
thousand volumes, relating to medical science, con- 
nected with the hospital. Just one word more 
about the destruction of this hospital and we pass 
on to give a sketch of the inner life in such an 
institution, as seen by a member of the resident 
medical staff. 

As the writer was lately passing the remains 
of the old building in a Broadway stage, a young 
lady sitting near him, on seeing the ruins, — the 
workmen were just pulling the ivy from the front 
wall, — exclaimed, " That is the work of those horrid 
doctors; they ought to be strung up." Now this 
expression is but a fair type of what is generally 
believed by the people of our city and country 
who do not have accurate information as to just 
how much the doctors have to do with the man- 
agement of such hospitals. The fact is that the 
Physicians and Surgeons of the New York Hospital 
have no duties in connection with the institution, 
except the care of the sick. There is not a physic- 
ian in the Board of Governors. It is true that 



THE OLD HOSPITAL. 9 

this Board confers with the physicians, and asks 
advice as to the care of the institution ; but so 
far as is shown by the two reports before referred 
to, while giving a great deal of deference to the 
opinions of medical men who died some seventy 
years ago, they paid no attention to the advice 
of their own board ; at any rate, to the governors, 
and not to the *' horrid doctors," should be as- 
cribed the blame or awarded the credit of the 
tearing down. 

This hospital would not have had an existence, 
without the efforts of the physicians, Doctors Bard, 
Jones, and Middleton, who founded it. It could 
not have been sustained if the labors of the long 
line of physicians and surgeons who visited the 
sick within its walls had not been gratuitously 
given, and yet medical men have not participated 
in its management. 

Many of the mistakes in the financial care 
and success of such hospitals may have depended 
on the want of cooperation between the medical 
staff and the directors. We beHeve it to be a 
radical error in the management of such institu- 
tions that the doctors are excluded from their full 
share in the directorship. The best hospitals we 
have ever had in this country, were those that 
were exclusively controlled by the medical officers 
of the United States Army. We disclaim any 



lO THE OLD HOSPITAL, 

idea, however, in this article of speaking by the 
authority of the medical staff of the hospital. We 
merely know that the demolition has been under- 
taken independently of them, and that the finan- 
cial or general management is in no sense shared 
in by them. 

Among the names of those who have served 
this hospital, we find some that have much more 
than a New York reputation : Wright Post, Samuel 
L. Mitchell, David Hosack, Alexander H. Stevens, 
Valentine Mott, John C. Cheesman, J. Kearney 
Rodgers, Joseph Mather Smith, Gurdon Buck. 
These were honored names throughout the land, 
and their successors, who are watching the throes 
of dissolution, have quite sustained the reputation 
of the medical and surgical staff. 

It is a common mistake to suppose that a 
hospital is a gloomy place. Gloom was not a 
common idea among the dwellers of the old pile, 
sad as were many of the scenes that there trans- 
pired. 

The patients lay in cheerful wards, chatting 
with each other ; they were covered by the whitest 
of bed-spreads, and attended by cheerful nurses ; 
the most of them had better food than they ever 
had before in their lives, and, what is better 
still, the great majority were getting well. Some 
of them, I am sure, relished so simple an injury 



THE OLD HOSPITAL. II 

as a broken leg, as an excuse for a good vacation. 
There is a story told that a man, who was 
admitted to the hospital in consequence of having 
been bitten by a rattlesnake, and who, in accord- 
ance with the then idea of proper treatment, 
was kept constantly pHed with brandy, remarked, 
on paying his bill and going out, that it was the 
cheapest and best hotel he was ever in, since 
he had all the liquor he could wish, and was 
drunk for two weeks, all for the small sum of 
ten dollars. 

The nurses were not unhappy, certainly not 
the females. They grew fat and lusty in the 
service, as the result of their good living and 
ample opportunities for gossip. Some of them 
served the hospital for twenty years, and then 
were pensioned off with the dignity of a room 
to themselves, and nothing to do. How some 
of them used to make the medical students stand 
around ! Tradition says, that years ago one of 
them applied a strap vigorously to the shoulders 
of a luckless wight, who, in his anxiety to hear 
the clinical lecture, leaned upon and rumpled one 
of her best made beds, on which castigation 
the grave attending surgeon smiled approvingly. 
The Superintendent, certainly, was not miserable, 
for he was an autocrat of the first water, and 
on the most confidential relations with the gov- 



12 THE OLD HOSPITAL. 

ernors. There was one person about the institution 
who may have been unhappy, that is " the man 
at the gate." He certainly had enough care to 
make him so. Tuesdays and Fridays, at three 
o'clock, the gates were open to all who had 
friends in the hospital. They began to gather 
about noon, and sometimes in such force as to 
make the gate-house look as if it were in a state 
of siege. Before these visitors entered, they were 
obliged to yield up all surreptitiously introduced 
cognac, and whisky, apple-jack, cider, cigars, oranges, 
and peanuts, with which creature comforts they 
intended to solace the tedious hours of their 
suffering friends. It was an amusing sight to look 
in upon the gate-house after such a foray, upon 
the first-class grocery estabhshment which had been 
set up from the pockets and skirts of anxious 
visitors. On other days than those mentioned, 
only the friends of the Superintendent, of the 
House Staff, medical students, high ojfficials, or 
those who had special passes from the doctors were 
allowed to enter. It was remarkable, however, that 
frequent attempts were made to pass, by those 
who fulfilled none of these requirements. Distin- 
guished gentlemen, claiming all sorts of relationship 
with all sorts of dignitaries, from the Governor of 
the State down to the keeper of the City Hall 
would daily apply for admission, but " John " was 



THE OLD HOSPITAL. 1 3 

inexorable. Occasionally, indeed, he had been hum- 
bugged so often, '* the man at the gate " denied 
admission to really distinguished strangers or citi- 
zens, whom curiosity had led up the broad walk 
between the old trees to the gate-house, which 
prevented any nearer approach to the famous old 
place. 

John's contentions and watching were finally 
ended by his death, and since then the name of 
" the man at the gate" has lost all its force. 

The doctors, we mean the house-doctors, were 
not unhappy ; there were nine of them, solemn 
young men, so young in appearance that we re- 
member that many an indignant patient, on seeing 
his medical attendant, would vow that " none of 
them 'ere assistants should ever practice on him." 

It should be known that what are called the 
attending physicians or surgeons are eminent prac- 
titioners in the busy city about, who visit the 
hospital daily, give the clinical lectures, perform 
the great operations, and direct the treatment of 
the serious cases. The " young doctors," as the 
patients call them, who are the resident staff, are 
divided into three grades, those of each grade 
serving a term of eight months. All these young 
men, however, are graduates in medicine, having 
spent three years in its study before being admit- 
ted, and then only after a successful competitive 



14 THE OLD HOSPITAL. 

examination. In the first eight months the ** junior 
walker," as he is called, has no responsibility, 
but he receives his orders from the house-surgeon 
or physician, according as he is on the medical 
or surgical "side." He dresses wounds, bandages 
limbs, cups, copies cases into a note-book, lunches 
every day at the expense of the hospital, but 
goes home at night. 

The senior walker dresses fractures, writes the 
history of cases as he takes it from the patient's 
lips, which the junior copies, while the house- 
surgeon, the only one of the three who lives in 
the hospital, has the general supervision of all 
the patients, subject, as before indicated, to the 
direction of the attending physician, or " head 
doctor," He often, however, has to act, in cases 
of emergency, requiring considerable experience and 
skill, which he has acquired in the previous six- 
teen months of pupilage. It will thus be seen 
that every precaution was taken by the by-laws 
of the hospital, to secure careful and skilful at- 
tention of the sick. There were three sets of 
these doctors, two on the surgical and one on 
the medical side, to care for about three hundred 
and seventy-five sick. 

Let us now go through with a day as passed 
by a house physician or house surgeon of the 
New York Hospital. We may suppose that the 



THE OLD HOSPITAL, 15 

young gentleman has breakfasted in the pleasant 
dining-room, from whence he has gone into the 
office, whose windows look out upon Broadway, 
where the clerk, a rare gentleman of the old school, 
has regaled him both with the odor of a fragrant 
Havana, and with some very well-told stories of 
the ancient regime, when New York was so small 
that all the good fellows knew each other ; and 
that he has looked out and seen his two assistants 
coming up the walk from their up-town boarding- 
house, or home. He then buckles on his armor, 
or, in plain English, he seizes his case of instru- 
ments, and with the senior and junior walker at 
his side, he starts on his rounds. The Emperor 
of Russia, the Viceroy of Egypt, the President 
of the United States, never felt more acutely the 
weight of supreme power than did the house- 
surgeon, or physician, of the New York Hospital, 
as he was about to pass into a realm over which 
he was the undisputed master. 

How the doors fly open ! Obedient nurses greet 
him, towel in hand, and he passes from bed to bed. 

''Well, John, how do you feel this morning? 
Nurse ! what sort of a night did the man pass ? 
What did he eat for breakfast ?" and at the same 
time feeling his pulse, putting his hands on his 
face to note the temperature of the body, while 
the senior walker is making rapid notes; these are 



1 6 THE OLD HOSPITAL, 

the questions, and this is the manner in which our 
young doctor attends his patients. No nonsense, 
no fuss, no haste, but calm sympathetic questions 
and gentle manipulations. 

Perhaps it is a stab, or perhaps a broken limb, 
or, if the case be in charge of the house-physi- 
cian, rheumatism or fever. A card at the head of 
the patient's little iron bed tells what diet he is 
having, what stimulant, if any, he is taking, and 
the doctor adds a beefsteak or chicken soup, or 
takes off a bottle of porter, or in his own way 
continues or changes the treatment. If he pre- 
scribes any medicine, he writes the prescription 
in a note-book, which goes afterwards to the 
apothecary's. And thus he goes through the 
seven or eight wards under his charge, seeing each 
patient personally, paying due regard to the ven- 
tilation and cleanliness, administering praise or re- 
buke to the nurse, advising with his assistants 
about the dressing of the injuries, noting in his 
mind the cases to which he will ask the particular 
attention of the attending surgeon when he comes 
at noon, until about ii o'clock, when his round 
is finished. Then the work of the senior and 
junior walker begins. They follow the house- 
surgeon, but in a much less ceremonions manner, 
and carry out his directions as to bandaging 
wounds, dressing fractures, and so forth. 



THE OLD HOSPITAL. 1/ 

The house-doctor has gone back to his room, 
where he receives calls of various kinds, now from 
a patient whom he has ordered to go out, and 
who wants his board signed, the one which was 
at the head of his bed, with his name, date of 
entry, and his disease. On this the doctor writes 
' D. C, " that is, discharged cured, or, *' D. R., " 
discharged relieved, or perhaps it is brought to 
him by the nurse, who says that its owner was 
out on pass yesterday, and failed to come back, 
and then " eloped " is written, or perhaps he is 
obliged to write " died." 

It may be a policeman who calls, with the 
compliments of Judge Finnigan of the Police Court, 
who wishes to inquire how that man is who was 
brought into the night ward stabbed, last night, or 
(if it was in the palmy days of the volunteer fire 
companies) who was hit over the head with a 
speaking trumpet. The Judge desires to know the 
man's condition, in order to bail the assailant, if 
the wound be not dangerous. Perhaps the caller 
is the Coroner ; he asks when the doctor will be 
ready to make that post mortein, the technical name 
for an examination of a dead body; or it is a 
nurse, who says that Hans Breitman, in ward 6, 
demands an extra beer to-day, which he claims 
was ordered for him, but which the nurse cannot 
make out. Hans was probably right, being the 



1 8 THE OLD HOSPITAL. 

more interested of the two. Or perhaps it is the 
senior walker, who requests his chief to come and 
look at Mulligan's fracture, now that it is undressed. 
It may be *' Aunty," an old colored nurse. Here 
we must pause an instant. " Aunty," as black as 
any black could be, dear old Aunty, the doctors' 
pet, who died in the service of the hospital, after 
many years of faithful work, — no history of the 
New York Hospital would be complete that did 
not mention her. An ardent abolitionist, she was 
yet particularly sweet on any Southerner, who 
might chance to be a house doctor, lest she should 
hurt his feehngs by the obtrusion of her pecuHar 
and obnoxious sentiments. Aunty nursed one 
doctor through the small-pox, another in typhoid 
fever, and was handed down from generation to 
generation as one to be carefully tended and hu- 
mored. Her services were manifold. She mended 
the doctor's clothes, she lent him money, and 
sold him pickles and blackberry brandy. In the 
little cubby-hole off the ward, over which she pre- 
sided, was a grotesque collection of chinaware, a 
daguerreotype gallery of the various doctors, and 
a full length picture of John Brown, who became 
one of her patron saints after the affair at Harper's 
Ferry. Aunty was an earnest Christian, and calmly 
passed to her rest a few years ago. At her funeral 
at St. Peter's Church, amid the throng of her 



THE OLD HOSPITAL. 1 9 

own race, who had assembled to pay the last 
tribute of respect to the old lady, were to be 
seen many of the governors, and officers of the 
institution which she had served so long and well. 
Now comes a visitor in the shape of some 
particular friend of some poor fellow in one of 
the wards, who wants to know what the doctor 
really thinks of his case; or perhaps it is "Old 
Jimmy," the man at the Duane-street gate where 
the carriages enter, who knocks at the door, and 
exclaims, " A man with a broken leg," or, " A 
man fell down a hatchway." No matter what 
occurs, old Jimmy's face is perfectly calm, unless 
it is a case of bleeding, when his pipe stays a 
little longer from his mouth, as he says, *' He's 
bleeding, sir, and they'll be wanting you quick." 
Then the doctor goes out, glances at the case, 
and if it be serious, and require immediate atten- 
tion, he passes with it into the ward, carefully 
examines the wound or injury, revives the patient 
with brandy or the "heater," that is, a hot-air bath, 
if suffering from what the medical men call shock, 
ties the bleeding vessels, calms the friends, tells 
the policeman the nature of the injury, and passes 
out. Thus the morning goes on, until a quick 
step, and a brief knock, and in comes the at- 
tending surgeon, the grand medical ]\Iogul. " Any 
thing new to-dav, doctor?" he asks. "Yes, sir, 



20 THE OLD HOSPITAL. 

a man has just come in with a stab in the chest," 
or, ** There is a railroad accident case," or, ** Only 
a fracture, or a burn." 

And then the students, who have been gathered 
in the halls, follow the doctors into the wards, where 
the round is made once more, the cHnical lecture 
is given, and perhaps an operation performed in 
the amphitheatre ; but, at last, all is done ; the 
students disappear, the attending surgeon stays 
behind a few moments for a word or two with 
the house doctor, and at last the door shuts, and 
the poor fellow knows that if it is his week for 
the night ward, or if he has many serious cases, 
his work is but half done. But first he dines, 
often not till five on lecture-days, although the 
hospital hour for dining is half-past two. He then 
goes out for a walk, and at evening makes another, 
this time a hurried, visit to the wards, takes tea, 
smokes a cigar, perhaps ; and at ten o'clock the 
Broadway gate is shut, the watchman begins his 
rounds about the wards to see if the nurses are 
at their posts, and the '' night ward " begins. 
Eleven, twelve, one, and then a rap at the doctors 
door. " A man in the night ward, doctor ! " 
** What is it ?" " I dont know ; he's bleeding, 
sir." With hastily donned slippers and dressing 
gown, down goes the house-surgeon to the night 
ward, a room in the lower part of the main house, 



THE OLD HOSPITAL. 21 

with four or more beds, for the reception of 
patients who are brought in between lo P. M. and 
6 A. M. There he is apt to meet the apothecary. 
an educated Irish gentleman, himself a good 
surgeon, who lives in the house. What sights 
that old night ward has seen ! There lies some 
rowdy quivering in his last gasps, stabbed nigh to 
the heart by an infuriated fellow, while his lately 
drunken, but now sobered friends stand by, for 
once shocked and appalled. Perhaps it is some 
poor wretch, who, after having made himself a beast 
with rum, has lain down in his vile den to sleep 
off his debauch, while his clothes have caught fire 
from the stove, or the over-turned kerosene, until 
he has been terribly burned, literally charred. Still 
unsobered, he hes cursing and shouting until the 
breath becomes feebler, and the poor soul passes 
away to give up its account. It may be that it 
is one whose dress and air show that he has a 
position in life better and higher, but whose steps 
have run to evil, and who is here the victim of a 
midnight carousal. Or it is 

" One more unfortunate 
Weary of breath, 
Rashly importunate, 
Gone to her death," 

but who now would call back the spirit she had 
just before endeavored to set loose, as she wildly 



22 THE OLD HOSPITAL. 

calls for the antidote that may save her life 
Life! why should she wish to go back to it? 
With her it means but a career of shame and 
suffering. But at last the work is done, and the 
doctor goes back to his bed, perhaps to be called 
again by the exclamation, " This man is dying, 
sir, in ward 4 ; " or, " Mrs. Smith is keeping the 
whole ward awake by her talking and says she 
won't go to sleep, unless I give her another 
draught;" or, it may be that the doctor is keep- 
ing vigils over some poor fellow, to whom it is 
necessary to give so much opium, that he must 
be carefully watched lest he become narcotized. 
If so, every hour or two he passes quietly into 
the ward, counts the pulse, made wondrous slow 
by the drug, puts his hand on the chest, which 
heaves so infrequently that there is a solemn 
pause between the respirations, notes the number 
by his watch, and with a grim smile of satisfaction 
that his dangerous remedy is so faithfully doing 
its work of subduing the action of that heart, 
which would else run riot and wear out its victim, 
creeps back to his room. And so, at last, the 
morning comes, and another day is to be gone 
over : and so on, for his term for eight months, 
until the poor fellow gives up his honors and his 
cares, to go out and tread the quieter walks of 
private practice, while the senior walker, gladly, 



THE OLD HOSPITAL, 23 

in his turn, goes through with the same earnest 
and exciting Hfe. 

Many of the incidents of the daily life in 
such an institution are thriUing enough to form 
the bases of romances ; but the events succeed 
each other with such rapidity in a large hospital, 
that they receive very little attention after they 
have once passed by, and the actors and witnesses 
are too busy to record them. Thus they become 
a part of the unwritten dramas of the world. 

The ward devoted to the sufferers from mania 
h potu, or delirium tremens, the " Del. Trem." 
ward, as the nurses and house doctors were apt to 
call it, would alone furnish scenes for the pencil of 
the artist, which might surpass those of Hogarth or 
Holbein, so frightful is the demoniac appearance of 
man when the victim of his passions, and overcome 
with awful dread at the horrid shapes which his 
diseased brain has pictured. The visitor to such a 
ward, when it is well filled, would almost imagine 
that he had entered one of the portals of the 
region of the lost. 

One poor victim lies muttering to himself, and 
constantly picking his bed clothes, now and then 
rising up and fixedly staring, with horror delineated 
in every feature, on some fancied demon emerging 
from a crevice or corner. Another is hurling back, 
with awful blasphemy, the taunts and jeers with 



24 THE OLD HOSPITAL. 

which his imaginary enemy is tormenting him, 
while in the grated room off the main ward, re- 
served for the most violent cases, a poor fellow is 
rushing madly about, fighting a mortal combat with 
what seems to him a real enemy. The strait jacket 
and well-padded walls, however, protect him from 
doing himself any harm, while the strong men 
chosen as nurses for these patients cow them down 
with a steady look, and preserve a Satanic order 
in this pandemonium. Occasionally, however, a suf- 
ferer from the effects of strong drink, sees gentle 
spirits and dreams delightful dreams, instead of 
fearful shapes and imaginations. A smile is con- 
stantly playing on such lips, and he seems like a 
child dreaming of angels. I well remember a poor 
artist, who had often suffered from delirium tre- 
mens, who told me that in his hours of insanity 
he saw images that Raphael or Angelo might have 
traced, and that visions of artistic beauty floated 
before him, which he could never execute in his 
sober hours, and yet the period of remorse and in- 
tense physical suffering came to him all the same. 
It is said that one patient has been in the hos- 
pital more than a dozen times ; but, as a rule, two 
or three attacks finish a career. The writer once 
heard an eminent Professor of Medicine say that 
he had no hopes whatever of the reform of a man 
who had once had delirium tremens. 



THE OLD HOSPITAL. 2$ 

The two wards that were devoted to Httle boys 
(very few Httle girls applied for admission) were 
very interesting places. The good women who 
took care of them were as kind to the waifs as if 
they were their own. The rooms \^ere ornamented 
with pictures, and texts of Scripture on illuminated 
cards ; and after the doctors had made their 
dreaded visits, and the danger of being hurt was 
over, it was a right cheerful place. The little fel- 
lows who were able to be out of bed would hobble 
around to those less fortunate, and chatter over 
their toys as cheerfully as boys who were well. 
They were mostly gamins, uncared for by father or 
mother, or, at least, very poorly watched over ; who 
had suffered accident from heedlessly jumping on 
or off street-cars, or playing on the track, or from 
similar carelessness. Occasionally, there was the 
victim of a carousal. One little Italian music ven- 
der, I remember, who was shot in the face and 
head with slugs from a revolver, in the hands of 
a man sitting nearly opposite him, in one of the 
dens of Baxter street. The motive for this terrible 
crime on the poor little child of some twelve years 
was never known. His swarthy father held him 
tenderly in his arms during the three or four days 
that he lived, responding to the wail that now and 
then came from his lips, in agonizing accents which 
rang through the ward. 



26 THE OLD HOSPITAL. 

The slaughter of the innocents, as it takes place 
in our large cities from carelessness and filth, is 
never more painfully seen than in the waiting-rooms 
of our dispensaries and the wards of our hospitals. 

" They look up with their pale and sunken faces, 
And their look is dread to see, 
For they mind you of their angels in high places. 
With eyes turned on Deity." 

This article should not be concluded without the 
statement that very much of the cleanliness, good 
order, and general efficiency for which the New 
York Hospital was famous, was due to the fact 
that the visiting and inspecting committees of the 
board of governors appointed from their own num- 
ber, whose duty it was to inspect the hospital once 
a week, to confer with the medical officers and 
superintendent, did their work thoroughly and well, 
although it must have been at the expense of their 
private affairs. The house staff" often met the ven- 
erable, but active president of the board in his 
rounds about the wards, and were stimulated to 
the performance of their duty by the zeal with 
which he did his. 

The '' doctors' mob," in the winter of 1787 and 
^ZZ, when the infuriated populace would have torn 
the hospital to the ground, because of the dissec- 
tion of dead bodies, which they supposed was car- 
ried on within its walls, and when they became so 



THE OLD HOSPITAL. 2/ 

infuriated as to stone the venerated John Jay and 
the gallant Baron Steuben, who were vainly endeav- 
oring to quiet them, is a part of the history of 
New York, and if properly treated, would require 
an article of itself. With this exception, the New 
York Hospital has always been on excellent terms 
with the people, and enjoyed a deservedly excellent 
reputation among them. Many a hard-working man 
has strictly enjoined his family to have him carried 
to it, in case any serious accident happend to him, 
preferring the care of its trained nurses and skilled 
physicians to that which his humble home could 
afford. May the time be not far off when it shall 
arise from its ruins, to again do its beneficent 
work. 

Since the foregoing was written, the New York 
Hospital has been re-organized, and a new building 
capable of accommodating one hundred and fifty 
patients, has been constructed on 15th St. It was 
formally opened seven years after the destruction 
of the venerable pile on Broadway. It has a beau- 
tiful, well arranged and expensive interior, but it 
faces a narrow and crowded street, and is more 
than five stories high. Despite its elegance, it is 
no fit successor to the venerable buildings sur- 
rounded by beautiful grounds, the loss of which I 
have deplored. The real work of the old Hospital 



28 THE OLD HOSPITAL. 

is carried on in Chambers St., in what is called the 
*' House of ReHef." The Bloomingdale asylum has 
not been removed to West Farms, but continues 
in its old position. The only part of the new hos- 
pital that may be said to be fairly in keeping with 
its history, now reaching over more than one hun- 
dred and nine years, is the Library, which is pre- 
sided over by one of the oldest and most esteemed 
officials of the institution, Dr. Vandervoort. This 
is one of the largest and best in the country. The 
Governors are entitled to the hearty thanks of 
the Medical Profession for maintaining and ex- 
tending it in such a manner that its value can 
hardly be overestimated. 



ANNIVERSARY ADDRESS 



'I 



II. 

ANNIVERSARY ADDRESS. 

Delivered before the Alumni of the Medical department 
of the University of the City of New York 
March 4, 1872. 

The character of the audience before which I 
have the honor to stand, composed as it is of 
those who are members of the profession of 
medicine, and of others who represent that body, 
known in their discussions as the laity, is an admo- 
nition that it will not be the time or place in 
which to enter upon a strictly professional or 
technical line of thought in what I may have to 
say. It may be assumed, however, that this is 
an assemblage of the friends of the medical pro- 
fession, and that a common field of interest may 
be found in some of the subjects that arise from 
the duties of medical men, and which are suggested 
by such an anniversary as the one we are now 
celebrating. 

The recurrence of the annual meeting of the 



32 ANNIVERSARY ADDRESS. 

alumni of the Medical Department of this University 
very naturally suggests, I think, an inquiry as to 
the benefits of such organizations. Why are they 
formed ? Of what use is it that we, who have been 
graduated in medicine from the same college, have 
banded ourselves together in an association with 
dinners, annual addresses, and treasurer's accounts? 

We can all at once see why men who, as boys, 
have lived in the most intimate social relations for 
four years, who have sat side by side on the 
recitation-bench for term after term, and who have 
finally, almost, if not quite, in tears, smoked the 
pipe of union, and planted the ivy of remembrance 
on the college walls, should unite in class and 
college associations to live over the days of auld 
lang syne ; but in the three years of a man's life 
as a medical student, and the few months of them 
that are spent under the roof of a medical college, 
there is very little of sentiment, and also very 
little that one would care to live over again. 

Very few of the students of a large class are 
well acquainted with each other. One term of such 
a life is often spent at a college in Michigan, 
another at one in Massachusetts or Virginia, and 
finally the graduation occurs in New York. So 
that very few of those who have sat together on 
the college-benches, and who have jostled and 
elbowed each other in the crowded wards of the 



ANNIVERSARY ADDRESS, 33 

hospital, are even very well acquainted, much less 
socially intimate. 

For these and other reasons that might be 
given, alumni associations of graduates in medicine 
cannot have, as their chief object, the renewal of 
old friendships and college memories. There is, 
however, as I believe, a great value in such 
organizations. It is a matter of regret that we 
have not had them for a longer time. Medical 
colleges have unfortunately sometimes gotten into 
the position of representatives without constituents. 
They have stood as it were alone. Their graduates 
have felt that their active interest in alma mater 
was gone when the diploma was obtained. Thus 
the colleges have lost the aid which a band of 
loyal alumni would always give, while the profession 
at large, which all medical colleges serve, have 
been unduly delayed in receiving the improvements 
in medical training which would undoubtedly be 
suggested by men who from years of active prac- 
tice have acquired ideas that even professors would 
be glad to adopt. 

Who is there who doubts that those honored 
universities. Harvard and Yale, have been largely 
the gainers since their alumni have taken an 
active interest in their affairs ? To no less an ex- 
tent, if the end can be properly attained, will our 
medical colleges be profited, and through them the 



34 ANNIVERSARY ADDRESS. 

whole profession, by alumni associations ; for, as I 
believe, and as I shall attempt to show, it is to 
the medical colleges that we must look for any 
great advance in medical education, and I was 
about to add, in medical science. 

Prior to the organization of this association, 
some six years ago, so little interest had the 
graduates of this college taken in their abna mater^ 
that, although she has an honored career of more 
than thirty years, and has graduated more than 
three thousand men, their history remained entirely 
unwritten, and they exerted almost no influence 
whatever upon the department. Many of the 
medical colleges in the country have been furnished 
with one or more professors who took their degree 
in the University of the City of New York. In 
every city, and almost in every hamlet of our 
land, in Canada, and even in far-off China, Syria, 
and Hindostan, her graduates were doing successful 
and honored work, and yet in the city whence 
they went forth there was not even an annual 
roll-call. To record this history was one of the 
objects for which this association was founded. 
That object will soon be accomplished, for the 
pubHshing committee are about to go to press 
with a catalogue which t trust will be a beginning 
in the work of rescuing names from obHvion which 
the world ought not to let die. 



ANNIVERSARY ADDRESS. 35 

But, far beyond any such purpose as this 
matter of history is the one which I hope will 
be fully developed in our subsequent career as a 
society. We should endeavor to increase the ac- 
tivity and resources of our alma mater in the field 
of science and medicine. By thus doing, we shall 
not only benefit her, but every other medical 
college in the land, or drive those that are past 
betterment into a deserved dissolution, 

We hear a great deal in our journals and 
societies of the elevation of the standard of medical 
education. The phrase has become so hackneyed 
that it has lost much of its force, and yet all of 
us will admit that there must be an advance if 
Medicine is to keep step at all with her sister 
arts and sciences. 

I know of no way in which this advance may 
be attained except through the medical colleges. 
To-day, a diploma from one of them is worth all 
other evidence as to the fitness of its owner to 
practise medicine, although we are all sorry to 
admit that even this is not always a guarantee of 
acquirement. Medical colleges, fond as the pro- 
fession is of reproaching them, have done more 
for the scientific education of medical men in our 
country than all other means combined. 

It is claimed on high authority, however, that 
medical colleges cannot fulfill the task of advanc- 



36 ANNIVERSARY ADDRESS. 

ing medical science, or of stimulating strictly 
scientific researches. It is undoubtedly true that 
only in a post-graduate course in university labora- 
tories and dissecting-rooms, where there are scholar- 
ships and libraries, and all that belong to liberal 
endowments, may we expect original and independ- 
ent scientific researches. But certainly, a medical 
college is better able to furnish this course than 
any other kind of an organization. Moreover, a 
very large share of all the scientific work that is 
done in medicine is done by the teachers and 
attaches of medical schools. Of ten papers read 
before our County Society during the last year, 
six were from professors in medical schools, and 
two of the remainder were from avowed clinical 
teachers. A reference to the catalogue of books 
pubhshed by one of our leading publishers shows 
that, with three exceptions, these books were 
written by professors in medical colleges. 

I am not here to claim that our medical 
colleges have come up to that which may be 
justly expected of them, but such as they are, 
without them, our societies, journalism, and litera- 
ture, could not live a day. I think we shall find 
that medical colleges have as high a standard and 
do as much for medical science as the profession 
demands of them. Just as soon as physicians, in 
such organizations as ours demand more, and show 



A NNI VERSA R Y ADDRESS. 3 7 

a willingness to assist in carrying out the plans 
proposed, the colleges will be glad to take great 
steps forward. But the grumbling of those who 
take no interest in medical schools, attended by 
spasmodic and impertinent expressions of con- 
temptuous opinions in regard to all the work of 
the colleges, will advance nothing. 

Why has Harvard Medical School fallen off in 
her students to the number of one hundred and 
five? Because her new standard is too high, or 
because she has no faithful constituency in her 
alumni, who, having been consulted in the changes 
made, have promised to sustain them? Did those 
one hundred and five men stay away of them- 
selves, or did their preceptors and the medical 
men about them allow them to do so ? I am far 
from saying that all the changes made in Boston 
should be adopted in New York, but I do say 
that the Harvard Medical School needs the pro- 
fession of New England at her back. 

There is certainly need for changes in our 
system of medical instruction. We have outgrown 
our garments to such an extent that we present 
almost a ridiculous appearance when viewed in 
certain directions. Yet what man of us would 
copy the entire system of medical instruction as 
it obtains in Germany or England, and incorporate 
one of those into our plans. 



38 ANNIVERSARY ADDRESS. 

Faulty as our system is, let us calmly see 
what it has done for us. The average American 
medical student, at the end of his course of three 
years, which is so largely voluntary, compares 
very favorably with the average German who has 
been engaged in medical studies for five years, 
in spite of the fact that the American often 
knows very little Latin and no Greek, while the 
German knows a great deal of each. Undoubtedly, 
the German system has fewer defects than ours, 
but no system will of itself make a scholar or a 
practitioner, any more than a bad system can 
prevent a man from being both. 

An impartial visitor to the wards of a German 
hospital, and to those of New York, Boston, and 
Philadelphia, will tell you that the Americans ex- 
hibit quite as good surgery as their transatlantic 
brethren ; and that which we technically call the 
practice of medicine will, I am sure, not suffer 
by the comparison. 

Again, where was there a better medical corps, 
one which did a nation more honor, than that 
which managed the medical department of our 
army in the late civil war? And to-day will not 
the medical staff of our army and navy compare 
well with that of any nation? Where has there 
been better scientific work than that which has 
come from Woodward, Otis, Curtis, and others. 



A N.VI VERSARY A DDRE SS. 39 

under the direction of the surgeon-generals? What 
organization did better medical service in the 
world's history than our late Sanitary Commission, 
managed, as to its medical details, by such men 
as Stille, Elisha Harris, Van Buren and Agnew ? 

All of these men were graduates at American 
medical colleges, and few of them have supple- 
mented the education there obtained, except from 
the resources of their own land. 

A system which has produced such results, and 
men such as these, should not be wholly con- 
demned. Its defects should be remedied, its virtues 
amplified, but no revolution should be made, al- 
though we know that our course of instruction 
must be improved. The nation and the world, as 
the centuries go on, are becoming more critical 
even as to the culture of their medical advisers. It 
is an undeniable fact that the diseases of our coun- 
try to-day are, so to speak, of a more refined nature 
than those of a hundred years ago. They are 
those of a civilization which is nearly the same in 
our young land, so rapidly is knowledge dissemina- 
ted, as that of peoples whose forests were cleared, 
and whose fields tilled and cities built, a thousand 
years ago. As proofs of this statement, let us 
consider the fact that such affections as the 
neuralgias, short-sightedness, affections of the brain, 
are greatly on the increase, especially in large 



40 ANNIVERSARY ADDRESS. 

cities. Thus we are approximating the civilization 
of Germany, where myopia is almost the rule 
among the educated classes. A writer on this 
disease, some sixty years since, Ware, quoted by 
Bonders, shows that, while short-sightedness was 
almost unknown among the privates of the English 
Foot-guards, it was very common in Oxford and 
Cambridge Universities ; in one college at Oxford, 
thirty-two out of one hundred and-twenty-seven, 
or about one in four, were short-sighted. 

Even in Germany, however, in the mountain 
villages, where the school-terms are short and the 
studies simple, myopes are rare ; while in a class 
of medical graduates, pursuing a special course at 
Berlin in 1862, nearly one-half of the Germans 
wore concave glasses. 

The number of publications on nervous disease, 
on wear and tear, the haggard looks of our over- 
worked men in all kinds of business and in all 
professions, furnish the evidence of a class of affec- 
tions of which our fathers knew very little. They 
were pioneers, forest-hewers, road-makers; we are 
the army of occupation in camp and garrison. 
Our course of medical education needs, then, in 
these times, more of detail and refinement to meet 
these enlarged requirements. Not but that we 
still, and shall always, need bold and skilful sur- 
geons for amputations, resections, and the removal 



ANNIVERSARY ADDRESS. 4I 

of tumors, and for the emergencies of the battle- 
field, for all the requirements of every-day ills and 
accidents ; but, we must have, besides them, the 
men who will make minute investigations in dis- 
eased tissues, who will study the shades of insanity, 
those who will adjust the cylindric lens to the 
astigmatic eye, and perhaps so learn the science 
of acoustics, that a sound reflector will be made for 
the deaf. Then again we must have experienced 
and large minded sanitarians, who will influence 
and participate in the Legislation that affects the 
public health. 

The course of instruction that was adapted to a 
time when there was no microscopic anatomy, no 
auscultation, no ophthalmoscope, no laryngoscope, 
no otoscope, and no clinical lectures, is certainly 
not entirely competent to fnlfill the requirements 
of our day. Attempts have been made on all sides 
to adapt our schools to these requirements, but 
some of these adaptations have made the state of 
things worse. We have more lectures, with the same 
number of hours of instruction. The old preceptor 
system, under which the medical student actually 
spent the time in the office or by the sick-bed at 
the side of his teacher, has fallen into disuse, to 
be replaced by a summer session which students 
attend or not, as they please, the fact being 
that not more than one in four does attend it. 



42 ANNIVERSAR V ADDRESS. 

It is true that we now have professors of almost 
all the branches of medicine, but many of them 
have no power of participation in the examination 
for a degree. It does not take much judgment 
of human nature to decide as to how many 
students will attend the course of instruction of 
a professor who has no power to compel attend- 
ance. As a practical result, many of the graduates 
have never attended such lectures. 

We can readily see how easily all this might 
be improved, not, as I have already said, by a 
revolution or convulsive change, but by a natural 
amplification of the means now employed. If at- 
tendance upon the spring and summer course 
were made obligatory, and if all the teachers 
except the assistants took part in the examination 
for a degree, the chief defects would be remedied. 
There is one part of the present system, however, 
for which mild measures will not do. There a 
radical change is necessary. Students of different 
degrees of proficiency should not be allowed to 
attend the same lectures. There should be a class 
system, and a graded scheme of study. This is a 
point that requires no argument ; it is only won- 
derful that the present arrangement has had so 
long a life. 

Some of the much-vaunted advantages of the 
present day, by which men who know nothing 



A NNI VERSARYA DDRE SS. 43 

of the nomenclature of the diseases of which they 
get perhaps a peep over the shoulders of a crowd 
around a sick-bed, vainly attempting to see and 
hear what only a dozen or two can look at or 
listen to, also need a radical improvement. Clinical 
instruction should not be addresses to a mob, but 
the systematized, Socratic teaching of a limited 
number, so that the student is obliged to take 
an active interest in the case before him. Much 
of the so-called clinical teaching is only by courtesy 
thus named. 

If I were to speak of the improvements that 
have been made in our present system, I should 
have a long list to go over. It would be a wel- 
come task to show how the medical colleges have 
advanced in the last twenty-five years. Since the 
foundation of this department in 1841, and mainly 
through that foundation, New York has become a 
medical metropolis, instead of being what it then 
was, with relation to Philadelphia, a mere provincial 
town. Then we had about one hundred students 
in one school, now^ we have a thousand in three 
flourishing colleges, with laboratory, dissecting-room., 
and hospital advantages which were then scarcely 
dreamed of even b\' the most enthusiastic promoter 
of medical education. 

But we, as alumni and friends of medical 
schools, are chieflv anxious to know what we can 



44 ANNIVERSARY ADDRESS. 

do to remedy defects. There are occasions enough 
for congratulation upon what has already been 
accomplished. 

I am also attempting to show that there should 
be changes, not the uprooting of the good parts 
of our American plan, substituting those which 
are foreign, and which in some respects need as 
much change as our own. I am aware of that 
intensely unpatriotic aud sycophantic view which 
looks at all our attempts at science, that are not 
after the European model, as failures ; that one 
which regards all our efforts in the way of educa- 
tion with contemptuous pity, about as we view 
colleges among the Cherokees, and Choctaws, and 
freedmen ; but I, nevertheless, hold to the belief 
that it remains for this country, and for the city 
of New York, to develop a system of medical 
teaching and a race of scientific men which shall 
have no superiors in the world. ^* 

As an illustration of the feelings with which 
some of our brethren across the sea regard our 
attempts to cultivate medical science, I may repeat 
an apocryphal story of what the great strategist 
of Europe thinks of our military science and art : 

It is said that Von Moltke declined to read 
any history of the late civil war, because it was 
an account of the proceedings of an armed mob. 

* See note at close of this Address. 



ANNIVERSARY ADDRESS. 45 

It is probable that the Prussian general was never 
so rude as to say any thing Hke this, and yet 
many of us know, if he entertains the same views 
with thousands of his countrymen, that this would 
not have been an unnatural expression. 

What we do need most, and first of all, in our 
medical colleges — a need which only alumni can 
fill by their influence and efforts — are endowments 
for professorships. The teachers should be free 
from any taint of desire of large classes, merely 
that their salaries may be increased. We need 
more opportunities for special studies and investi- 
gations in chemical and physiological laboratories, 
in the dissecting-rooms, and the clinical wards. We 
also need libraries and scholarships, in short, what 
money will bring — money not to be spent on the 
outside of the cup and the platter, the college 
building and the lecture-room, but for the support 
of men who are willing to labor for science, if 
science can give them their bread-and-butter. 

The money that now goes to found new univer- 
sities in Montana and Nevada should stay in our 
Eastern colleges, that now have the buildings, 
but sadly need the internal essentials for making 
them of use. 

The wealthy country, which owes a debt to the 
medical profession, not by any means paid, is 
willing to assist in endowing these chairs, and in 



4^ ANNIVERSARY ADDRESS. 

founding these scholarships, as I have no doubt 
they would if a proper appeal were made to it, 
such a one as Chancellor Crosby has so successfully 
made in behalf of another department. Surely the 
discovery of the anaesthetic powers of sulphuric 
ether, an agent whose value cannot even be 
estimated, deserves some more fitting reward than 
a monument of brass in the public garden at 
Boston. Those who are grateful for that which 
has robbed the surgeon's knife of nearly all its 
terrors, can do no greater honor to the memory 
of Morton, who suggested and urged upon Warren 
the use of this blessed agent, than by founding 
chairs, which shall cause other pain-stilling, death- 
preventing remedies to be discovered and com- 
pounded. 

Our lack of opportunity for scientific work in 
this land has caused us to do too much in the 
way of translating and editing, and comparatively 
too little original work. 

But it is not altogether want of means that 
has prevented us from taking the rank which, as 
inheritors of the accumulated culture of the Old 
World, we might have claimed. The visitor to 
the ancient University of Leyden, founded when 
a nation was engaged in a struggle for existence, 
to which our late war was but mimic strife, who 
has expected palatial halls and gorgeously-furnished 



ANNIVERSARY ADDRESS. 4/ 

lecture-rooms, must be surprised when he looks 
upon the humble surroundings of such men as 
Boerhaave, who did for our science and art what 
will ever make Dutchmen flush with pride. 

And in Berlin and Vienna, as the student of 
to-day lingers with the mighty masters of those 
schools, he will see that the means at their com- 
mand are not those of external surroundings. The 
most of their advantages are open to us. They 
are in brief, brains, and objects upon which to use 
them. We should cease our efforts to become 
merely fluent discoursers on other men's opinions; 
we must, by habits of close observation, begin to 
have opinions of our own. If men with large 
opportunities are too busy to use them, some of 
their redundant practice should go to their needier 
brethren, while a little work is done for the pro- 
fession. Men with four or five hospital appoint- 
ments, and who are candidates for more, should 
resign some of them, and work for science, instead 
of hurrying to get from one half-accomplished task 
to another. In our cities, and even in our hamlets, 
there is many a busy, and wise, and successful 
practitioner of medicine, who will go down to his 
grave with facts full of interest locked in his breast, 
discoveries denied revelation, not because their 
possessor is unwilling, but because he is too busy, 
to tell them. 



48 ANNIVERSARY ADDRESS. 

We need in this country, where pecuniary suc- 
cess does so much more than it ought to secure 
social position, to beware, as scientific men, of 
the struggle for crowded consulting-rooms, and an 
unending round of engagements. The admiration 
and even the gratitude of the crowd are things of 
to-day, while the rewards of a devotion to science 
and charity are eternal. 

One of our gifted countrymen,* a laborer in 
another and a higher calling than ours, has read 
us practitioners of medicine a lesson that we need, 
in his apt commentary on the old French proverb, 
noblesse oblige. This motto of men of rank and 
privilege is of itself an argument for professional 
work into which the idea of pecuniary reward does 
not enter, and it cannot be too thoroughly es- 
teemed by us. 

Even with our present system of education, if 
each one of us embraced his opportunity, the 
New York school would soon be quoted, not for 
the number of its graduates, but, like those of 
London, Paris, BerHn, and Vienna, for its scientific 
discoveries. 

Brethren of the alumni of this college, let us 
do something for our school that shall redound 
to the glory of alma mater, and the honor of our 
land. We may, with our more than two thousand 

* Rev. Edward E. Hale, Old and New, Sept., 1871. 



ANNIVERSARY ADDRESS. 49 

living graduates, become a power in the cause of 
medical reform. We are more than two hundred 
even in this city and suburbs, although the Faculty 
have never aimed to make this a local college. 
Our organization here should be so strong, and 
have such a purpose, as to engage the sympathies 
of our brothers even in the remotest parts of the 
earth. 

In the patient performance of the duties that 
pertain to such organizations, there is none of the 
eclat attending brilHant professional efforts, but 
there will certainly be laurels invisible to the 
multitude, but forever seen by those who honor 
earnest work for the general welfare. 

May I now, leaving this subject of the work 
of alumni associations in the advancement of medi- 
cal education, still further trespass on the patience 
that has heard me thus far, by a brief discussion 
of some of the relations of medical men to the 
laity ? My excuse for thus abruptly following in 
the track of my predecessor, our distinguished 
President, may be found in the fact that, while 
the medical profession is often criticised, it has 
few opportunities for answering these criticisms. 
Hence we are justified in availing ourselves of 
those which are offered. 

The basis upon which physicians estimate their 



50 ANNIVERSARY ADDRESS. 

fees is not always as well understood as it should 
be. Not but that they are cheerfully paid as a 
rule. Yet a successful or unsuccessful result in 
the treatment, the propriety of which is not 
questioned, is often unduly taken into considera- 
tion ; unduly I say, for I assume that your medical 
advisers are as careful and as painstaking in their 
unsuccessful as in their successful cases. 

We are often judged by the rules that apply 
to mechanics, whereas it is evident that their 
materials are a little more reliable than ours. 
Cause and effect are somewhat clearer in work 
upon wood and marble, than in efforts to heal 
the flesh and purify the blood. Physicians fret 
and chafe a little under the strictly pecuniary 
view of the value of their services. They do not 
consider themselves as mere laborers for hire. I 
am sure the public at large does not, or we 
should not have, as one of our greatest blessings, 
the poor always with us, in the treatment of 
whose ailments the money question can never with 
any propriety enter. 

The fee is to us, what our code of ethics 
styles it, an honorarium. For, who can estimate 
in dollars and cents the value of a life saved ? 
Who can set a price to a disabled organ or limb 
restored to usefulness. 

In spite of these theories, which all but suicides 



A NNI VER SARY ADDRE SS. 5 ^ 

are supposed to entertain, how often do we hear 
a murmur against that rara avis, a thousand- 
dollar fee ? The exceptional man who gets it is 
usually past the middle of a life that has been 
wholly given up to science and humanity. How 
often, again, is a fee complained of, because the 
physician decided that there was no disease pres- 
ent, or because the prescription was unavailing? 

The medical profession is far from wanting a 
change in the present system, by which the ho- 
norarium is paid for conscientious effort, no more, 
no less, whether the result be a cure or failure, 
to arrest the disease. Yet if we were paid for 
lungs and throats, eyes and limbs, for health and 
life, due under God to our efforts, according to 
their market value as estimated by their possessors, 
we should have a much greater pecuniary reward 
than now, even if we received nothing in those 
cases where the treatment was unsuccessful. But 
such a system would destroy our sympathetic 
relations to our patients, and our calling would 
lose all of its sacred nature. 

There are several anecdotes floating about our 
city, relative to the subject of fees, which may or 
may not be true, but which, after all, illustrate 
the paternal relations existing between tried and 
trusted medical advisers, and their patients, such 
as obtained in the times when people did not 



52 ANNIVERSARY ADDRESS. 

change their physicians as readily as they would 
a garment. 

It is said that the late Dr. F., for so many 
years the chief attraction of many circles of our 
society, once sent in his annual bill, which was 
about as large as usual, for medical services ren- 
dered the family of one of his most valued friends, 
when, in point of fact, he had not been in the 
house professionally during the entire year. The 
bill was paid as usual, but, when the head of 
the family met Dr. F., he remarked : " Doctor, I 
got your bill the other day, but I don't remember 
that any of us have been sick this year." '' Very 
likely not," answered the bluff man of science ; 
"oh no, but I stopped several times at the area- 
gate, and inquired of the servants how you all 
were." For that year at least the good man was 
paid on the Chinese principle. 

The late Dr. S., who was for many years one 
of the prominent medical men in New York, is 
said to have once sent in a bill for three hundred 
and forty-two dollars and ninety-two cents, oi 
some similarly odd sum. This curious bill was 
also paid, but when the patient met his physician 
he inquired : '' How, doctor, did you ever get that 
odd ninety-two cents in my bill?" ''Oh," said 
the doctor, "that is easily explained: my grocer's 
bill was just for that amount, and I knew of no 



ANNIVERSARY ADDRESS. 53 

one who would so cheerfully pay it as yourself, 
and so I made one pay the other." 

There has often been in this countn^ and, 
judging from what we read, in England also, a 
chronic difficulty between laymen and physicians 
in the management of hospitals and similar public 
charities. In other words, the directors and the 
medical board do not always get on well together. 
This difficulty has not arisen from any kind of 
natural antagonism between the two kinds of 
people that make up these two bodies. There is 
practically no such antagonism. 

This difficulty, jealousy the one of the other, 
has arisen, as it seems to me, from the separation 
of the two bodies, which have a great affinity 
when in normal proximity, but which become very 
repellant when separated. Distrust has been en- 
gendered by the Chinese wall that has been built 
up between them in the administration of public 
charities. 

Physicians and laymen should be on the same 
board and with equal powers, while the special 
work of each body is done by means of sub- 
committees. The most of the matters pertaining 
to the management of such institutions are of such 
a character that doctors have quite as much 
interest in them as laymen. 

One of the noblest charities that the world 



54 ANNIVERSARY ADDRESS. 

has ever seen, the New York Hospital, which 
owed its origin to Dr. Samuel Bard and Dr. John 
Jones, has been, as many believe, virtually annihi- 
lated, certainly has lost years of its existence, 
because physicians had no voice, except an advisory 
one, in its management, and hence could only 
issue a protest against its destruction. After years 
of discussion, because the land was very valuable 
for business purposes, and the funds for its sup- 
port were not raised, a site that should have been 
sacred as long as the wharves and warehouses 
of New York are between the Battery and Twenty- 
third Street, was leased and the work of the hos- 
pital stopped. Now, our only down-town hospital 
is a little building, formerly an engine-house, at the 
edge of the Park ; while those not fortunate enough, 
when injured or sun-struck, to gain admittance to 
the crowded little ward, are gently transported by 
ambulance three or four miles to Bellevue. 

I think the statistics, as to the situations in 
which casualties occur, will show that there was 
never more urgent need of a hospital down-town, 
of the high character of the one that is now suf- 
fering such an interregnum, than to-day. It is 
commonly believed in the profession that there 
never would have been an interruption in the ca- 
reer of the New York Hospital, had the medical 
force had its full share in its government. Its fame 



ANNIVERSARY ADDRESS. 55 

certainly depends upon the character of this latter 
body, although every one cheerfully admits the high 
quality of the generous services of its distinguished 
Board of Governors. 

One of the eminent men who form the Board 
of Governors of the Society of the New York Hos- 
pital, in an interesting centenary address, asserts 
that its grave has been pathetically and fancifully 
dug, in an article by your speaker, in Putnams 
Magazine. To this I can only reply that its grave 
has not only been dug, but its remains so deeply 
buried beneath the storehouses of Worth and Duane 
Streets, and Broadway, that probably not one of its 
present Board of Attending Physicians and Surgeons 
will be present at its resurrection. 

When in all hospitals, as now obtains in some, 
physicians and laymen meet together as equals to 
consult in mutual good faith, distrust will disappear 
and each class will find that there is no great dif- 
ference between them after all ; that doctors and 
laity are men of like faults and virtues. 

Sir Henry Holland, that eminent physician whose 
life reaches over almost three generations, says of 
our army hospitals of the late civil war that he 
has never seen them equalled, and he has seen 
those of most of the nations of the world. All 
these hospitals were organized and managed, even 
to the minutest detail, not by practical business- 



56 ANNIVERSARY ADDRESS. 

men, with great wisdom in finance, but by phy- 
sicians. 

Our profession is perhaps wholly to blame for 
the present system of separation between the 
boards. The management of hospitals has not 
been wrested from them by a jealous laity, but 
they have allowed the latter class to assume all 
the troublesome care and responsibility of the man- 
agemen:t of the institutions to which they are med- 
ical advisers. 

Sometimes physicians seem to have assumed 
the position of upper servants, not to the poor in- 
mates of the hospitals whose servants true physi- 
cians always are, but to boards of direction. It is 
no wonder, then, that tradition tells, according to 
the address at the last anniversary of the alumni 
of the College of Physicians and Surgeons, that the 
incoming governors of one of our hospitals were 
instructed to *' keep their feet on the necks of the 
doctors." 

Laymen are often greatly exercised over the so- 
called etiquette among doctors, and we are familiar 
with the complaint that there is too much cere- 
mony with each other, when a patient desires to 
change his physician, or when he desires to call 
in consultation one of the believers in a dogma, 
an '' eclectic," " hydropathist," or the like. 

It is probably not as well known as it should 



ANNIVER SA RY A DDRE SS. 5 / 

be, that we have in the medical profession a sys- 
tem of laws, called the code of ethics, to the ob- 
servance of which we are just as much bound as is 
a good citizen to the laws of his countr}^ 

If this code be wrong, it becomes our duty to 
seek to amend it, but, so long as it stands the 
medical law of the land, we are each one of us in 
honor bound to abide by it. I think that any 
careful examination of this code will show that, 
on the whole, its rules of etiquette are no more 
burdensome than the unwritten laws of good so- 
ciety. It is only to be regretted that our medical 
society is as yet in this countrj^ so uncr^-stallized 
that we need laws to regulate the common proprie- 
ties of intercourse among gentlemen. 

The occasion does not permit of a full analysis 
of this code, although I may beg you to give me a 
few moments upon some parts of it. The code cer- 
tainly was framed in the interest of the patient. 
The rule which deprecates even the friendly visits 
of a physician to the patient of a brother practi- 
tioner is an example of the extent to which this 
protection goes. For how easy is it by a depre- 
cating look or shrug to give a sick friend the idea 
that, while all that may be very well for him^ we 
never employ such a mode of treatment ! 

Our code says that it is derogatory to the dig- 
nitv of a medical man to resort to public advertise- 



58 ANNIVERSARY ADDRESS. 

ments inviting the attention of individuals affected 
with particular diseases, to boast of cures and reme- 
dies, to adduce certificates of skill and success, or 
to perform any similar acts. In short, the code 
says we shall not attempt to advertise skill. This 
law sometimes elicits surprise ; and yet who would 
be willing to see the daily newspapers and the 
dead walls placarded with the notices of the skill 
of our eminent jurists and theologians in trying 
cases and in converting souls? 

If our abilities as healers of the body were to 
be generally advertised, the difficulty sometimes 
complained of, of not knowing to whom to go for 
the treatment of serious disease, will be by no means 
remedied, for the practice of medicine would then 
be a race in which the cunning user of printer's 
ink would win. It is certainly wise, and in no re- 
spect derogatory to the highest character, for a 
man to advertise that he has a thousand bales of 
cotton or a cargo of tea to sell; but where is the 
honest man who shall presume to advertise that 
he is a sure healer of the ills of human flesh ? 

The medical profession is sometimes thought to 
be very unbusiness-like because it obeys that part 
of the code which forbids its members from hold- 
ing a patent for any surgical instrument or nos- 
trum, or from in any way keeping secret from the 
brethren the virtues of a remedy. 




ANNIVERSARY ADDRESS. 59 

Let me suppose that a physician in San Fran- 
cisco discovers a remedy for a blighting disease, 
and it is well established that he has alleviated 
or cured many in that city who are suffering from 
it. If a loyal man, he at once, through the medi- 
cal press, informs his brethren throughout the world 
of what he has learned, and we in New York are 
soon enjoying the benefits of his knowledge, which 
is now the common property of the profession. 
Now, let us reverse the picture, and suppose that 
our San Francisco friend would not tell his secret 
except to those who visited him personally, and 
paid for it, must we in New York go unrelieved 
because we are not able to go to him? This 
case, though an extreme one, covers the whole 
ground of argument on this question. The spirit 
of this wise provision of our code gave us ether 
as an anaesthetic in New York almost as soon as 
Morton and Warren had used it in Boston ; and 
chloral was quieting pain in the sick-chambers of 
our metropolis immediately after Liebreich had 
tested its virtues in Berlin. 

Systematic violation of this article of our code, 
which places the knowledge of one within the 
reach of all, would soon sweep our libraries and 
medical press from existence, and transform a lib- 
eral profession into a number of mercenary trades- 
unions. 



6o ANNIVERSARY ADDRESS. 

Our profession has lately been brought to blusn 
for one of its members, who formed a company 
for the exclusive sale and charlatan-like advertis- 
ing of a drug which is to banish cancer from 
among the scourges of our race. If it were really 
what the calm judgment of the profession, that 
has fairly tried it, shows it not to be, cundurango 
would need no company for its sale, other than 
the individuals and firms that now faithfully dis- 
pense the well-tried medicines of our pharma- 
copoeia. 

It would be better far that one medical dis- 
coverer should go down to his grave in the dregs 
of poverty, than that, by his becoming enriched 
from the exclusive sale of ether and chloral, 
thousands should be deprived of the mitigations 
of anaesthesia and anodynes. The duty of our 
profession is plain : no trade secrets — no patent 
rights in things medical. 

The question as to whether we should consult 
with men who honestly believe, or seem to, that 
cold water is a panacea, or with those who, dis- 
carding all the results of chemistry and physiology 
and pathology, believe that symptoms, and symp- 
toms alone, are worthy to be studied, and are 
then to be healed by mysterious drugs redolent 
of the dark ages, whose potency increases with 
their dilution, and that diseases are cured in con- 



ANNIVERSARY ADDRESS. 6l 

sonance with what they are pleased to call a law, 
that like cures like, is a delicate one to argue in 
the face of a New York audience. Perhaps some 
of my friends are ready to ask, why should they 
who have so simplified the treatment of disease, so 
that every one with a book and numerous phials 
of granules is a competent medical adviser, consult 
with the murdering old fogies who blister and 
leech, and give mercury and opium, and whom 
they are pleased to call allopaths. 

I do not propose to discuss this question at 
all, but I beg to state why we in the regular 
profession reject the name of " allopath," which 
the dogmatists have attempted to fasten upon us, 
and to show what we really are, what are our 
aims, what -we have achieved, as well as the un- 
reasonableness of those who call us illiberal ; and 
then leave you to decide where the name of phy- 
sician, the only one we claim, really belongs. Our 
profession does not believe in any one dogma ; 
hence we cannot be disciples of de curatione per 
contraria — nor of de curatione per siniilia. These 
are all fancies with which our practical and catho- 
lic school of medicine has nothing to do. They 
are finely-spun theories woven in the days when 
pathology, and chemistry, and physiology — in other 
words, exact objective examinations on the living 
and dead subject, and in the chemical laboratory 



62 ANNIVERSARY ADDRESS. 

— had done nothing for the cure of disease ; when 
men were writers not on what they had seen on 
the body, but of what they imagined in the dreams 
of their study, and when they were readers of 
musty tomes, instead of being in the wards by the 
source of all medical books, the patient. 

We of this age should have no interest in these 
theories ; we are simply physicians, as yet unaware 
of the fixed but mysterious laws that others claim 
— who now, as always, will use any appliance or 
any remedy that, judging by experience in their 
use, or from well-settled mechanical, chemical, or 
physiological principles, will cure disease. We re- 
ject no one from our ranks who acts in this man- 
ner. We allow the largest liberty in the employ- 
ment of remedies, although we cannot believe that 
cold water is the only means of treatment; that 
no remedies are of value except they belong to 
the vegetable kingdom ; or that the value of all 
drugs is increased by attenuation and dilution, and 
that they all act in accordance with the so-called 
law that Hke cures Hke. In short, we believe with 
one of our eminent physiologists. Dr. B. W. Rich- 
ardson, that " dogmas in medicine ought henceforth 
to be allowed no moment of life; every step of ad- 
vancement in curing disease must be a single step, 
proved by its own excellence, based on its own 
merit. It must be like a chemical experiment, 



A .VXI VER SA RY A DDRE SS. O 3 

the details of which are known, and are suscepti- 
ble of being tested and demonstrated by every 
competent practitioner." 

The regular profession, the true one, is certainly 
to be found with us who claim the name. She is 
to-day the custodian of all the great hospitals of 
the world, from. Constantinople to London, from 
New York to Pekin. Even in Leipsic, where Hah- 
nemann once flourished, and whence he was to 
revolutionize the medical science of the world, a 
statue is the principal evidence that the pretender 
ever existed. The student of medicine, who visits 
the Old World for instruction, will find that not 
one of their great schools has swer\'ed from the 
ancient but progressive faith. He will return a 
disappointed but a wiser man, if he expects to find 
a school where the dogmatists are teachers. 

The literature of the practice of medicine, from 
Hippocrates down to our own Watson and Xie- 
meyer, is ours, and does not contain a line of com- 
fort for absurd theorizers about the principles upon 
which remedies act. The anatomical and physi- 
ological researches of Galen, Valsalva, Eustachius, 
Corti, with hundreds more down to Helmholtz, 
Richardson, Flint, Dalton, and Draper, of the nine- 
teenth centur}^ form one of the quarterings on an 
untarnished shield. 

The surgical achievem^ents of Pott and Larrey, 



64 ANNIVERSARY ADD'RESS. 

of Syme and Simpson, of Cooper and Dieffenbach, 
of the Posts, Parker, and Mott, of Stromeyer and 
Billroth, of Langenbeck, Erichsen, Fergusson, Bige- 
low, Sims, Van Buren, Pancoast, Sayre, and Gross, 
are the glory of the regular profession, in which 
the adherents of dogmas have no part. Pathology, 
the offspring of modern time, is one of her chil- 
dren, and she points with pride to such names as 
Rokitansky and Virchow, Strieker, Robin, Claude 
Bernard, and Beale. 

In special researches, where, outside of her ranks, 
can be found the peers of Mackenzie, Arlt, and 
Bowman, Wilde, Troltsch, Gruber, and PoHtzer, 
Bonders, Hebra and Wilson, Emmet and Learn- 
ing, and what body but the regular profession is 
the guardian of the memory and fame of Albrecht 
von Graefe? Thus I might go on, and the recital 
of names would be but the enumeration of triumphs. 
They belong to a profession which though often 
stigmatized as illiberal, has always freely given to 
the world the results of her labors. To that catho- 
lic profession all true laborers for science are wel- 
come. There is room enough beneath the folds of 
her standard for all the diversities of honest opinion. 
She means to be liberal and humane in her deal- 
ings with error and ignorance, while her honors are 
reserved for the wise and loyal. 

The following statistics, which are from official sources, show 



ANNIVERSAR Y ADDRESS. 65 

what claim New York has to be considered a University town. The 
number of Academic and Professional students actually in attendance 
during the year 1879-80, is here exhibited as follows : 

Academic Students 934 

Scientific " " 620 

Theological" " 234 

Medical " " 1780 

Law " " 541 

Dental " " 99 

Veterinary " " 76 

Pharmacy (not official) lOO 

Total Students ., .4,384 

In addition to this aggregate there were 3,355 enrolled students at 
the Union for Science and Art founded by Peter Cooper. These figures 
show that New York is one of the great university centres of the 
world, and. that its reputation as a Commercial MetropoKs is nearly 
equalled by its renown as a city of Colleges. No city in this country 
can at all compare with New York in the number of its University 
Students. 

Since this was written, two medical institutions 
have been founded and safely established which have 
largely increased the number of professional students 
in New York. These are the Post-graduate Medical 
School and the Polyclinic. More than 800 physi- 
cians from various parts of the United States, Canada, 
South and Central America and the West Indies 
attended these medical colleges during the year 
1888-89. 



THE COMING MEDICAL MAN. 



III. 

THE COMING MEDICAL MAN. 

Delivered before the New York Academy of 
Medicine. 

Mr. President and Fellows of the Academy 
OF Medicine. 
Gentlemen : It is said, that when the victo- 
rious German armies had fairly entered France, 
after their recent contests on the frontiers, each 
general officer was furnished with full and accurate 
maps of the whole country to be traversed, even 
to its brooks and cross-roads, so that the entire 
force was soon in possession of a knowledge of 
what was ahead sufficient to enable it to go on 
with that confidence, which is so often the fore- 
runner of success. These maps were prepared years 
before, when the two great nations, who afterward 
engaged in deadly strife, were at peace, and many 
of the feet that had often pressed wearily upon the 
roads and by-ways of France, for the purpose of 
making the charts that were carefully copied in 
the war-office in Berlin, had no part in the tri- 
umphant march that finally ended in Paris. Yet, 



/O THE COMING MEDICAL MAN. 

though unseen, they were none the less among 
their triumphant countrymen, and mankind awards 
to them also the laurels of the victor. 

This kind of preparation for what may be in the 
future should not be, and is by no means, confined 
to the necessities of soldier-craft and war. The 
same spirit of anticipating the wants of the future 
is common to us all, and we are constantly build- 
ing castles we shall never inhabit, and making maps 
we shall never use. Fortunate will it be for us if 
the structures that we raise are ever inhabited ; if 
the plans that we make are ever of use to coming 
m-en, even if that use be the very slight one of 
showing that we aimed at something better than 
we had. 

In the hour that has been assigned me by the 
council of this Academy, I propose to indulge in a 
little map-making, which it is hoped may in some 
small measure show the manner of the future ad- 
vance of the medical profession : or I shall venture 
to give a sketch of what, as it seems to one mind, 
are to be some of the increased functions of the 
medical man of the future. I do not propose, how- 
ever, to discuss in any fullness the subject of the 
probable future increase in our exact knowledge, 
nor to group and classify the gaps that exist in the 
territory of our science and art. This would cer- 
tainly be an agreeable task, for the anticipation of 



THE COMING MEDICAL MAN. 7 1 

a land yet to be possessed is a cheery one, but it is 
one that has been often well performed, and I trust 
will be again. But, for the purpose of the present 
discussion, it will be assumed that this progress will 
constantly be made, and our view will simply regard 
the results of this continued advance of the science 
of medicine in the position of the coming medical 
man. 

Upon a subject so vast, and one which is depen- 
dent in its mode of presentation to so great a 
degree upon the habit of thought and opportunities 
for observation of the writer, I shall endeavor to 
speak without dogmatism, and certainly with no 
claim to entire correctness in the views presented. 
One mind can but outline such a subject, and even 
then some of the lines may be incorrectly drawn. 

Although we may all have a just pride in the 
present position of our science and art, we are still, 
consciously or unconsciously, looking forward to the 
coming medical man, as to a being with more know- 
ledge and wisdom than ourselves, who shall have a 
higher position than that of the physician of to-day. 
We are none of us quite satisfied with the present 
state of medical knowledge, or the present scope of 
the functions of medical men. This want of satis- 
faction is no evidence that we are a race of grum- 
blers ; far from it. Such a feeling is perfectly con- 
sistent with the most patient and cheerful work. 



72 THE COMING MEDICAL MAN. 

and with a decided sense of contentment in that 
work. I am happy to believe, however, that the 
annual address to be delivered before this Academy, 
one hundred years from to-night, will be full of 
hope for the future, or, if you will allow your im- 
agination to go so far, that, a thousand years from 
now, we shall have a race of medical men, still not 
content with the position of their present, nor satis- 
fied with the memory of a mighty past. Indeed, if 
we ever settle down into a state of satisfaction with 
ourselves, we may consider our prospect of further 
enlargement of position and duties as hopeless. In 
these days, too, when distinguished scientists " pro- 
long their vision backward across the boundary of 
experimental evidence," we as hopeful students of 
medical science, may be allowed to prolong ours for- 
ward, and map out the pathways and roads upon 
which we hope either we or our successors are to 
march. 

There are several relations, which I may, per- 
haps, classify under three heads, in which the com- 
ing medical man will occupy an advanced and en- 
larged position from the one of to-day : 

I. In relation to matters pertaining to education. 

By matters pertaining to education, I mean 
not only the education of the child, but also that 
of the man, or education in its largest sense. In 



THE COMING MEDICAL MAN. 73 

his relation to the present system of educating chil- 
dren and youth, the physician is in a position that 
often becomes embarrassing, and which is some- 
times wrong. He stands powerless in the midst of 
abuses that he cannot correct, and he seems to 
aid and abet them. We have practically nothing 
to do with the education of young children. On 
every hand in this city (and I fear the state of things 
is worse in other places) we see puny children going 
to and from school with books tied in their straps, 
or in their satchels, almost numerous enough to 
form a small private library. Indeed, their number 
is quite as large as, if not greater than, that used 
by students in colleges in preparing their daily 
tasks. These books are said to contain the lessons 
to be made up after school-hours, hours that begin 
at nine and end at two or three o'clock. We hear 
of these children being kept after school for trifling 
misdemeanors, still bending over books, and in the 
short twilight of these winter afternoons we may 
see the little innocents, who are thus undergoing 
their gradual but certain martyrdom, hurrying home, 
meanwhile prattUng over their day's misfortunes, 
without having had one full hour of complete rec- 
reation, or an ample meal since they were hurried 
out of bed to a hasty breakfast and off to school. 
We see their little forms wasting, their soft bones 
bending, their eye-balls lengthening and thus pro- 



74 THE COMING MEDICAL MAN. 

ducing short-sightedness from too continuous em- 
ployment in the crowded school-room, and over 
the study-table at home, but our advice is not asked 
until the deplorable consequences are painfully evi- 
dent. Even then the great anxiety of parent and 
teacher, an anxiety often yielded to by the physi- 
cian, seems to be, not to get and keep the child in 
a physiological condition, but to enable him to go 
on, without any interruption of his very important 
study of books — the incorrect notion being held that 
education consists wholly in the study of printed 
words. We are sent for when the defective sewer- 
age, the leak in the waste-pipe, the over-crowding 
and insufficient ventilation and lighting of the 
schoolroom, the want of physical exercise and 
food, the excessive employment of the brain, have 
done their work, and we have to deal with a 
febrile, short-sighted, catarrhal, and puny patient. 
We are expected to cure the fever, to put glasses 
upon the eyes, and set the poor machine at work 
again, without a remonstrance against the system 
that has produced all this misery. We have not 
until very lately, been asked to look after the pub- 
lic and private school-houses, to see how the seats 
are constructed, or the rooms lighted and aired, 
to examine into the drainage of the college-grounds, 
to prescribe the diet and the proportionate hours 
of study and exercise. Perhaps we should not all 



THE COMING MEDICAL xMAN. 75 

know how to perform these duties well, were they 
required of us, but they will certainly be among 
the functions of the coming medical man. 

Some of the most horrifying reading of the day 
is contained in the annual reports of the New York 
Prison Association. In them are found detailed 
accounts of the condition of the Tombs Prison and 
of the county jails throughout the State. The 
dampness, filth, and overcrowding of some of these 
places are set forth in a manner so graphic that a 
report of facts becomes highly sensational. If a 
committee v/ere appointed to go up and down the 
land, visiting our colleges, public schools, academies, 
and seminaries for young women ; and if this com- 
mission should be brave enough to tell the whole 
truth about insufficient drainage of grounds, imper- 
fect ventilation, and Hghting of rooms ; if they 
were to tell how many hours were devoted to 
study, sleep, and exercise respectively ; what was 
the quality of the food ; how many recitations oc- 
curred when the stomach was entirely empty, or 
containing only stimulating but slightly nutritious 
liquids ; if they told also how many young women 
were violating ordinary physiological precautions — 
we should have some more of the same kind of 
literature as that furnished by the Prison Associa- 
tion, except that it would deal with a much pleas- 
anter class of subjects. If an investigation were 



r6 THE COMING MEDICAL MAN. 

even made as to the quality of air in the lecture, 
rooms of our medical colleges, where, among other 
things, lectures on hygiene are delivered, I think 
this commission would have a somewhat startling 
report to make on that subject ; and, as for our 
churches, it has long since been decided by the 
architects that a sufficient quantity of fresh air is 
not to be obtained in them. 

The medical man of to-day lives in the very 
midst of these abuses. He attends the churches, 
he lectures in the colleges, where he is poisoned 
by carbonic-acid gas. He even goes into the schools 
as a medical adviser. He is permitted to vaccin- 
ate the young ladies when there is an epidemic 
of small-pox, and to deliver lectures upon anatomy 
and physiology, and here his work usually ends : 
but I am glad to say that it ends, not because the 
medical man is entirely unconscious of his true 
duties, but because he is not allowed to perform 
them. Even the educated people, and we indeed 
ourselves, have not learned in any but an indefin- 
ite and most uncertain manner that the true func- 
tion of the medical adviser is not so much to cure 
as to prevent disease. Yet we are looked upon in 
some quarters, on account of our feeble remon- 
strances against the enormities of some of the 
educational systems, as natural foes of education, 
and especially of that of young women. However 



THE COMING MEDICAL MAN. 77 

that may be, the coming medical man will wage re- 
lentless war against the abuses that now obtain in 
our schools and colleges, and will finally overthrow 
them. We need only more such good work as that 
of Dr. Cohn, of Breslau, and' Dr. O'SuUivan and Dr. 
j3ell, of this Academy, to give us the facts as to our 
school-rooms, which by their poor lighting and over- 
crowding are producing so much short-sightedness 
and worse diseases, to excite a contest which will 
be short, quick, and decisive. In Prussia, where the 
need for soldiers seems to be more felt just now 
than any other, the government has been induced 
to remodel its school-houses, in order to preserve 
the coming generations from an amount of myopia 
which threatens to decimate their armies by the 
exemptions on account of this defect of vision. 
Even the models of school-houses exhibited in Paris 
and Vienna, at the great Expositions, and examined 
by Dr. Cohn, were defective, as to their lighting and 
seats, in quite a large proportion. How the average 
New York school-room, which was once a drawing- 
room lighted only in front and rear, or the college 
recitation-room, with one or two windows and an 
uncovered, flickering gas-burner to assist in picking 
out the Greek text on the short afternoons of No- 
vember, would appear in such a report as that of 
Dr. Cohn, it is needless to show. 

In Germany, where education is compulsory, and 



78 THE COMING MEDICAL MAN. 

the ordinary letters, both written and pnnted, are 
much more difficult to decipher than our Latin 
characters, where populations are crowded, and 
school-rooms often wedged in among other build- 
ings, the disease of short-sightedness has become 
almost a scourge. Our rural and backwoods school- 
houses, our long summer vacations, when the older 
children are in the hay and harvest field, as well as 
our simpler curriculum of study, and perhaps a 
richer diet, have as yet allowed us to escape from 
their proportion of this disease. But, in our large 
towns especially, the causes that have been enu- 
merated are producing graver as well as the same 
affections, while defective nutrition is giving rise to 
vast numbers of cases of insufficient development of 
the eyeball, and its consequent convergent squint. 

Another great evil in our public schools, that 
has lately been pointed out by Dr. Bell, is that 
children who are getting well of zymotic diseases 
are allowed to return to school without a physician's 
certificate, and thus expose hundreds of well chil- 
dren to danger. I need not dwell longer upon the 
necessity for active medical interference both in 
the household and in the school-room, for the pur- 
pose of regulating our educational systems, espe- 
cially as they affect the growing youth. It m.ust 
be obvious that the coming medical man will have 
a wider field for work in this department of educa- 



THE COMING MEDICAL MAN. 79 

tional matters than he now assumes, or than is al- 
lotted to him. 

As regards the higher or university education, 
when the students are of such an age that hygienic 
supervision is not, for many and apparent reasons, 
so necessary, the physician of the future, as one of 
the educated classes, will, I believe, have much more 
influence than we have obtained, and our part of 
the university training of the future will receive a 
fuller respect and support. There seems to have 
been quite as much interest in medical education 
in New York one hundred years ago, when three 
young men received the first degrees in medicine 
that were ever granted in this country, as there is to- 
day. Unfortunately, with the growth of our city in 
business importance, the desire to make it a uni- 
versity town, which then pervaded many of the 
prominent citizens, seems to have been lost sight of. 
An effort has been made to build up academic col- 
leges such as flourish in small towns ; and while 
these, well as they have done their work, and re- 
nowned as are their teachers, do not successfully 
compete with the other colleges of the land, the 
idea that New York is preeminently the place for 
true university training, and not for academic 
schools, does not seem to have been grasped but by 
very few. Law schools, schools of medicine and 
theology, have no difficulty in attracting students 



80 THE COMING MEDICAL MAN. 

to this city, but as yet the general public do not 
see that these should be the objects of especial aid 
and care on the part of our citizens. The mass of 
our educated people seem to have no regard what- 
ever for our medical colleges, except so far as there 
is a little personal interest from the relations of 
sons and brothers who are connected with them 
as teachers or students. This is about the same 
interest that is felt in well-regulated boarding or 
day schools, to which they have some personal at- 
tachment. These colleges are unendowed, except 
by the good-will of the profession and the money 
of their founders, and the founders are usually the 
faculty. They have done a good work in keeping 
our profession abreast of the knowledge of the 
famously-equipped colleges of the Old World, as 
well as a fair amount of original investigation, with- 
out money and sometimes without the sympathy 
of any but their teachers and students. 

The lack of endowments is the cause of many 
sad results. Among many others, we may note 
the fact that many young men soon give up all 
thought of contributing any thing to the general 
professional knowledge by original investigation, 
because after a short effort of this kind, without the 
aid of post-graduate courses, they have been obliged 
to fall into the ranks of those who labor primarily 
for bread-and-butter, and secondarily for science. 



THE COMING MEDICAL MAN. 51 

Worse still, here and there a few, with a noble but 
mistaken ambition, have labored without means to 
combine scientific laboratory-work with the busy 
hfe of a general practitioner, and when the struggle, 
as it usually must be, was too great for them, they 
have succumbed to the physical consequences of 
overwork, and they lie in the church-yards, ** mute, 
inglorious " scientists, with those virtues circum- 
scribed which might have blest their race, had not — 

" Chill penury repressed their noble rage 
And froze the genial current of the soul." 

Whatever may have been the additions that the 
medical profession of this country have made to 
the common stock of knowledge, and they have 
been neither few nor unimportant, they would have 
been largely increased by facilities at all equal with 
those enjoyed in the Old World. We have the 
men with the brains, but alas ! up to this time, the 
educated people have about decided that whatever 
they may do about ministers, lawyers, and teachers, 
doctors must educate themselves. By the aid of 
their fellowships, endowments, and other university 
establishments, the workers of England, France, and 
Germany, have been gathering harvests for decades 
Trom fields in which we have only put in here and 
there a sickle. The coming medical man will, I 
believe, so impress himself upon the wise and gen- 
erous people about him, or perhaps make himself so 



82 THE COMING MEDICAL MAN, 

important a character in the State, that he will have 
the means, now debarred the men of our time, for 
making investigations which shall lengthen life and 
mitigate disease. 

Although a learned profession, we have allowed 
jurists, theologians, and students of other sciences, 
to assume the entire control of our higher educa- 
tional system, until it is actually beheved, in many, 
and high places, that medical colleges are by no 
means a part of university systems, and that all 
they can expect is a kind of quasi-re\a.tlon to them. 
It is quite enough, it is assumed, if the mantle of 
the name of a great college covers their wants. 
This very city is every year giving hundreds of 
thousands of dollars to educate boys at Schenectady, 
New Haven, Cambridge, and Princeton, while it is 
paying very little for the instruction of men in New 
York ; that is to say, undergraduate instruction is 
receiving all favor and encouragement, while post- 
graduate learning, the hardest to get, the most 
important for the nation (for the other will be got 
in some way or other by private means) is without 
assistance. There never, perhaps, was a better field 
for a university system than New York. We could 
soon increase our number of say two thousand 
students of medicine, law, divinity, art, and pure 
science, to five times that number, to the manifest 
benefit of our country in all relations, had we the 



THE COMING MEDICAL MAN. 83 

money to pay eminent men for teaching, and to 
found fellowships as prizes for the few who prove 
worthy of special and enlarged facilities. As it is^ 
those of our young men, who can afford it, cross the 
ocean for what they ought to find at home. 

Our wants are simple ; we do not need an edu- 
cational system on the basis of that of England, 
with its gorgeous piles of architecture, the accumu- 
lated riches of centuries of national life, but we may 
be content with very simple exteriors, provided ap- 
paratus and laboratories, libraries and scholarships, 
are furnished us. 

We have now three medical colleges, each doing 
its work in an earnest and successful manner, but 
where they leave their graduates, we need a higher 
training to step in, and supplement or amplify their 
work. These colleges should also have the entire 
sympathy and active cooperation of all men who 
wish well for their country and themselves, for the 
safety of every citizen, the restriction of pauperism 
and crime, depend very largely upon the kind of 
physicians they graduate. Already New York re- 
ceives students from the oldest countries of the 
world, from China, Japan, India, and Armenia. Had 
we ample university facilities for them, they would 
come in hundreds and carry back knowledge which 
should do much to make the world akin. New 
York commands some of the ablest divines of our 



84 THE COMING MEDICAL MAN. 

time. Its law courts are perhaps only second to 
those of London in importance. Our press scatters 
its issues over the whole world, with an influence 
only limited by a knowledge of the English tongue. 
Our hospitals, dispensaries, and infirmaries, afford 
the opportunities for the study of almost every 
form of disease. Where there are now hundreds at 
the doors of these departments of human learning, 
the coming man will see thousands, if our people 
are wise in time. The Government of Switzerland 
with a wisdom that every summer exemplifies, in 
the material prosperity that it brings, at an outlay 
of money that is simply enormous, has built mag- 
nificent highways over its Alpine passes, and planted 
places of rest on every beautiful prospect. Even 
poor Norway traverses its valleys and plateaus with 
roads that are the envy of Americans, simply to 
attract travellers to its fiords and waterfalls. If 
we, in educational matters, were to imitate the wis- 
dom of these countries in their material affairs? 
if we were to open the avenues for science in 
this city, we should see ways, hitherto inaccessi- 
ble and unoccupied, constantly traversed, and new 
points of observation incessantly occupied, and from 
these facilities would come results as important to 
the world as those New York inventions — the navi- 
gation of rivers by steam, and the transmission of 
news by electricity. 



THE COMING MEDICAL MAN. 85 

II. In sanitary science. Before entering upon the 
consideration of the probable relations of the coming 
medical man to sanitary science and systems, I will 
venture to answer a question which is sometimes 
asked in a semi-jocose way. While its solution is 
too remote to be thoroughly practical, and it is never 
perhaps asked in great seriousness, there is in that 
which suggests such an inquiry, such a want of ap- 
preciation of the real functions of a physician, that a 
moment's attention to it may perhaps be pardoned. 

The question to which I allude, roughly stated, 
is about the following : " Are not you doctors work- 
ing against your own calling, when you are expend- 
ing so much zeal in attempting to prevent people 
from being sick ? What will you have left to do, 
when sanitary science is so perfected as you are 
endeavoring to make it?" There are several ob- 
vious answers to this question. The medical man of 
the future will, it is true, have his duties somewhat 
changed by the advancement of sanitary science, 
but at the same time they will be greatly amplified, 
so that physicians will be more numerous in the 
future than now. Sanitary science does much to 
prevent epidemics of fever, small-pox, and cholera ; 
but our kind of civilization increases all the wants 
of men, and demands not simply a sound mind in 
a sound body, but a perfectly-working mind in a 
perfectly-working body. 



86 THE COMING MEDICAL MAN. 

It was a wise man who said that " he that in- 
creaseth knowledge increaseth sorrow." All the ad- 
vancements that are made in the world cause us 
to be more exacting of our brains, our eyes, our 
ears, and perhaps of all our organs. For example, 
a Modoc Indian does not care about eye-glasses for 
near and fine work, because he does not do anything 
that requires any close use of his eyes ; but educate 
the savage, or, going much higher up in the scale 
of humanity, educate the ploughman, and he will 
soon be critical, not only as to glasses at all, but as 
to their curvature. Still higher, make of him a 
professor, or a clergymen, or a microscopist, and he 
will begin to worry over a slight degree of hyper- 
metropic astigmatism, and he will inv-ent glasses 
that shall not only make him see well, but the very 
best possible. Take another example : contrary to 
old notions, physicians generally have been teaching 
the public for the last few years that a discharge of 
pus from the ear is always a serious affair. This 
correct teaching has not only materially lessened 
the cases of this dangerous affection, but has taught 
people to consider the causes which may produce 
otorrhcea, so that all pains in the ear and all sore- 
throats are being carefully considered, and thus the 
work of the physician has been actually increased. 

In former times, if a man showed some little 
eccentricity in action, he was quietly tabooed as a 



THE COMING MEDICAL MAN. 8/ 

queer stick ; or, if he became somewhat violent in 
his eccentricity, the strait-jacket and the kindred re- 
straints of what was appropriately called a mad-house, 
put him entirely out of the way. But the present 
medical man, and the coming one still more so, 
will diagnosticate the especial disease of the brain — 
for he considers insanity as much a material disease 
as jaundice — and place his patient in a hospital 
where he is to be cured and restored to society. 

The modern appliances for the detection and 
cure of disease are simply the exponents of de- 
mands of mankind for the greatest amount of good 
work from good bodies, and we shall go on in these 
inventions and discoveries until the days of man 
are lengthened, and his physical capabilities are 
largely increased. Our good friends, the laity, may 
comfort themselves with the delusive hope that 
when vaccination has become universal, cholera 
and yellow fever completely banished, cancer and 
consumption curable, systems of ventilation and 
sewerage perfected, fever a myth, doctors and their 
bills will be alike unknown ; but, at the dawn of this 
physical millennium, we shall still have the birth 
and death of man, railway, steamship, and balloon 
accidents, and above all the superintendence and 
maintenance of the sanitary reforms and systems 
that are to prevent disease. Besides all this, so 
long as men refuse to obey the laws of health 



88 THE COMING MEDICAL MAN. 

that are plainly set before them, they must receive 
their punishment in requiring the services of phys- 
icians. 

It is to the medical profession that the general 
public must look for the main part of the work of 
what is technically called sanitary science, and that 
profession must be regarded as the final arbiter 
in all strictly sanitary questions. Yet the medical 
man of to-day has but a limited control over these 
matters, and in some places he has no control at 
all. We must not hastily ascribe this anomalous 
state of things, in which those whose mission it is 
to prevent and cure disease are restricted to the 
latter function, entirely to the influence of those not 
in the profession. Physicians themselves have been 
often forgetful of their high calling, and have ne- 
glected their plain duties. The loyalty of the great 
mass of the people, high and low, and especially 
the low, to the medical profession, is something to 
make us all profoundly grateful, and at the same 
time ever alert for the best interests of those whom 
we serve. 

Medical men are just awaking to the great im- 
portance of sanitary science, and we cannot expect 
those not directly engaged in the studies of the 
laws of health to be farther advanced than the 
students. The University of Glasgow has just recog- 
nized the necessity for positive teaching on sanitary 



THE COMING MEDICAL MAN. 89 

subjects, by the appointment of professors with 
charge of this subject. Our own country, after 
supplementing the work of the medical department 
of the army in an admirable sanitary commission, 
has organized a National Health Association that 
gives promise of an important work. In fact, we 
are in the midst of a sanitary revival. 

But, as to the details of the influence and con- 
trol of the physician of the future in sanitary af- 
fairs, there is much to be said. It is only within a 
few years that this city has had, except in times of 
epidemic disease, what it now enjoys, a board of 
men who know something about the important 
matter of health intrusted to them. It is a popu- 
lar idea that, while to be a good watch-maker a 
man must be brought up to the business, to be- 
come a doctor in medicine, and to have authorita- 
tive opinions about medical science, one requires 
no especial knowledge. Hence, there have been 
Boards of Health who knew nothing of the pres- 
ervation of health as a science, and even now 
properly-constituted boards have very little power 
to enforce the sanitary regulations which they re- 
gard as necessary. Many intelligent, well-instructed, 
I had almost said well-educated people, have not 
yet learned that they have no more actual right 
to enforce decided opinions upon the subject of 
preventing and curing disease, than well-educated 



90 THE COMING MEDICAL MAN 

cabin-passengers in an ocean steamer have to the 
avowal of authoritative ideas as to how the ship 
should be steered, or its engines managed. But, 
we have only as a profession to begin to show, by 
our devotion to our science and art, as a science 
and as an art, that we are what we claim to be, 
the proper guardians of the health of the people, 
to deserve, at least, to have our authority as much 
respected in all sanitary matters as is the Health 
Officer of the Port of New York, when his flag is 
seen, and his boat runs across the bows of an in- 
coming steamship. 

The insufficient influence exerted by the medi- 
cal man of to-day in great sanitary questions may, 
I think, be illustrated by the teetotal crusade of 
the West, and the hydrophobia panic in New York. 
Whatever may be the individual views of the medi- 
cal profession as to the expediency of ever using 
alcohohc fluids as a beverage (and I suppose we 
differ among ourselves on that point as much as 
other men), we are all agreed that the habitual use 
of distilled Hquors, in contradistinction from light 
wines and beer, is highly injurious to the health 
and longevity of the human race. We are also 
agreed that the adulteration of liquors adds greatly 
to the dangers of intemperance. Yet, so imper- 
fectly have we done our work of inducing restraint 
in the use of distilled liquors, and of attempting 



THE COMIXG MEDICAL MAN. 9 1 

to substitute less intoxicating drinks for the na- 
tional stimulant, whiskey, as well as of preventing 
the adulteration of liquors, that war was lately 
waged in many of the towns and villages of the 
West, actual war, against the liquor-saloons, which 
an unhealthy moral sentiment had created. How- 
ever great the evils of intemperance, a state of 
civil war will never overcome them, no matter with 
what motives undertaken. 

In New York, in the summer of 1874, there 
occurred a panic that filled many a household with 
terror, because the majority of a board of city rulers 
enacted and enforced a law on a sanitary subject, 
which had the opposition of the medical profession, 
both officially and unofficially expressed. In order 
to guard our city against that fatal but very rare 
disease, hydrophobia, our idle young lads were 
educated at the public expense in theft and blood- 
shed, and such an unnatural dread and animosity 
were excited against man's most faithful friend of 
the brute creation — an animal whose life was per- 
haps as valuable as that of some of his persecutors 
— that a dog upon the island of Manhattan bade 
fair to be as great a rarity as the now extinct dodo. 
Our Board of Health was powerless, as it often un- 
fortunately is, to do any thing more than to pro- 
test, while ignorance celebrated its triumph in the 
brutalities of the dog law. The coming medical 



92 THE COMING MEDICAL MAN. 

man, by his exact knowledge, and his improved 
means and increased power for disseminating and 
enforcing that knowledge, will exercise such a con- 
trolling influence on sanitary matters, that total- 
abstinence crusades and dog-wars, will be unneces- 
sary and unknown. 

The medical profession has no desire to with- 
hold scientific information from all those whom it 
may benefit, and undoubtedly our facihties for the 
spread of such knowledge will be increased, so soon 
as w^e can be assured that it will be prized and 
respected. But, with our insufficient authority, we 
have not as yet found, in many cases, a means of 
influencing the public mind without at the same 
time leaving a suspicion that there has been an 
advertisement of skill in curing disease, a thing that 
has been always repugnant to the tastes of the 
scientific as well as practising physician. The com- 
ing medical man will certainly announce his opin- 
ions on special subjects more than he is now able 
to, but they will probably be found in the form of 
well-considered conclusions to be directly presented 
to the lay authorities whom they are designed to 
influence. 

Yet, as I have before indicated, the little power 
that medical men have to enforce their sanitary 
opinions, sad as it is to say, is due very largely to 
their own supineness and want of practical judg- 



THE COMING MEDICAL MAN. 93 

ment. There are countries in the world where 
scientists and especially medical scientists abound, 
men learned in all the causes and consequences of 
disease, and yet, in these countries so accustomed 
have people become to the foulness of filthy out- 
houses and open sewers, that their cities and towns 
have become odorous enough to cause the average 
inhabitant of a less scientific country to regret the 
natural keenness of his scent. The studies of the 
laboratory and dead-house will produce no respect, 
unless their results are seen in a practical lessening 
of the sources of disease. We must see to it that, 
in becoming scientific about sanitary matters, we 
do not cease to be practical, or the coming medical 
man will have no more influence than does the one 
of to-day. 

It has been for a long time taken for granted 
that Boards of Health, Commissioners of Quarantine, 
etc., are to be not only largely made up of men 
without medical education, but that the boards are 
to be at the control of partisans who look upon 
the management of sanitary boards as rewards for 
party services. The time is coming when, whatever 
we may have of civil service reform in other quar- 
ters, we shall certainly have it in the care of the 
health of the people. With what satisfaction would 
the intelligent citizens of the State greet the reform 
which announces that our Board of Health, and 



94 THE COMING MEDICAL MAN. 

our Commissioners of Charities and Corrections, 
were beyond the reach of partisan control, ap- 
pointed during life and good conduct ! In the fut- 
ure we shall see all this care of the health and 
charities of the city and State lifted far up above 
the vicissitudes of political strife. 

The day is also coming when the medical re- 
sponsibility for the condition of asylums for the 
bHnd, and deaf and dumb, and for that of general 
hospitals, will be far greater than it is now. What 
may be done for the comfort of those who are 
considered hopelessly blind, but who yet, in a few 
instances have some sight to be preserved and in- 
creased, certain of us have had occasion to see in 
watching the practice of a Fellow of this Academy, 
who is one of the surgeons having the care of the 
eyes of the inmates of our Blind Asylum. The 
wisdom which provides special attendance even for 
the almost sightless eyes of the inmates of the 
schools for those who are educated without the 
aid of vision, will finally be imitated not only in 
all colleges for the blind, but in those for the deaf 
and dumb. In the latter-named places about one- 
half the inmates are there from causes that oc- 
curred after birth. In very many of these cases 
the disease that caused the deafness still exists, 
and shows itself in various ways ; and yet these 
hospitals, for hospitals they truly are, much as the 



THE COMING MEDICAL MAN. 95 

name may be disliked, usually have only physicians 
to attend the acute cases of general disease, while 
the suppurating ears and swollen throats are ne- 
glected. 

Our great hospitals are usually supposed to be 
wholly in the care of the profession, and we are 
held responsible by the average public for their 
faults, while the credit is usually given to them foi 
their beneficial results. Yet, as a rule, the profes- 
sion is only responsible for the direction of the posi- 
tively medical treatment. They have nothing to 
say, except in the way of advice, as to the location 
general management, the quality of the supplies, 
and so forth, upon which so much of the efficiency 
of hospitals depends. Almost the only hospitals in 
the country, for whose sanitary condition phys- 
icians are completely responsible, are those under 
the control of the Medical Departments of the 
Army and Navy. These hospitals, during our late 
civil war, when they were upon a scale seldom 
equalled in any country, were entirely under the 
management of medical men. There was no added 
financial wisdom from gentlemen learned in com- 
mercial pursuits. The record of these hospitals is 
certainly one of which a nation may be proud, for 
they have become models for the world. In them 
the medical profession not only exhibited its skill, 
but also vindicated its ability to assume the con- 



96 THE COMING MEDICAL MAN. 

trol of its own affairs. In spite of the lessons thus 
taught, many of our large hospitals are still con- 
trolled by Boards of Managers, none of whom are 
physicians. Yet it seems evident that the layman 
who gives or provides the money, and the physi- 
cians who oversee the medical work, should sit 
side by side in the committee-room, and together 
direct and control the great object of their labors. 
Our profession, by accepting a system which 
excludes them from the directorships of hospitals, 
has lost one of its best opportunities for influenc- 
ing the mind of a generous and educated laity. The 
day has long since passed away, even in the country 
whence we obtained our notions on this subject, 
when there is anything hie the relation of patron 
between the director and physician of a hospital. 
The relation may possibly nave existed in the time 
of fulsome dedicatory epistles from authors to noble- 
men, or when Dr. Johnson waited in the anteroom 
of Lord Chesterfield, but no one thinks of such a 
one now. The full recognition of the true relations 
will be experienced by the coming medical man 
when in all our great establishments for the care of 
the sick he sits down with nis brother philanthropist 
to look into the affairs which they together control. 

III. In the State. In aiscussing the relations of 
the medical man to the Sfe2,t:e, we are very likely to 



THE COMING MEDICAL MAN. 9/ 

think first of the regulation by the government of 
the quahfications for the practice of his profession. 
As matters now stand, any person who chooses 
may practise medicine. It is true that a law was 
passed by the last Legislature of our State, which 
prohibits any one from practising who has neither 
a license from a county medical society nor a di- 
ploma from a medical college. This law bears on 
the face of it an attempt at the protection of the 
public from quackery. But, when we find that 
there are three county medical societies and five 
medical colleges in this city, and that only one of 
these societies, and three of these colleges, would 
be recognized as competent authorities in medical 
education by such bodies as the Royal College of 
Physicians of England, our notions as to the value 
of such protection from the State must materially 
change. When there are no sects in medicine, and 
when the necessary qualifications of a physician are 
pretty well understood by our law-makers, it is 
probable that such laws may be of service, but it is 
hard to see how this legislation is any other than 
meddlesome, which will in no wise benefit those 
for whom it was ostensibly framed. As yet, it 
seems as if our ancient but ever-progressive profes- 
sion must avoid entangling alliances with a State 
that has no proper conception of our position and 
claims. The evil of irregular practitioners and sects 



98 THE COMING MEDICAL MAN. 

in medicine is founded in ignorance, and we must 
perhaps patiently await better sentiments among 
those who call themselves physicians, and the laity, 
before we can hope for such relations with the gov- 
ernment as will elevate our own standard and pro- 
tect the people. If this law be left on the statute- 
book, and enforced, it is probable that every one 
who has the least desire to practice medicine will 
be furnished with a license or a diploma, and thus 
the legal qualifications will be rendered perfect, but 
the actual fitness will remain the same. The com- 
ing medical man will hve in a day when all diplo- 
mas will be valuable, when there will be no sects in 
medicine ; then, perhaps, the State and our profes- 
sion will be in closer alliance. There is, however, a 
kind of allegiance to the State, which we all fully 
recognize, that of giving voluntary service, which 
our education enables us to proffer ; and we would 
not like to forget that, in becoming physicians, we 
do not cease to be citizens who are interested in 
all that pertains to the public weal. 

The reader of our national history, especially of 
its details, as contained in its old journals and 
monographs, must be struck with the fact that 
there was a time, in New York City at least, when 
the physician appeared somewhat more as a citi- 
zen than he does now. There was not quite so 
much of the class feeling which separated the med 



THE COMING MEDICAL MAN, 99 

ical man from his fellow as now. Some of the 
causes which have produced this state of things 
are unavoidable in the growth of a great city, the 
change in the character of medical studies, the gen- 
eral dislike to mix with affairs that have any tinge 
of mere party politics in them, and so forth ; but it 
is greatly to be regretted that the profession has 
not of late developed more men with very decided 
social and (in the high sense) political influence. 
However learned and scientific we may become, 
and to be such a profession is undoubtedly our 
chief aim, we are still in this country, of all the 
countries of the world, citizens, responsible to the 
State. When so much of the legislation of the 
country must of necessity be turned, in these lat- 
ter and in the coming days, toward sanitary affairs, 
the profession of medicine may well inquire whether 
we may not have duties in the matter of instruct 
ing that legislation. In no way can that be done 
so well as by a representative and experienced 
medical man, having the confidence of his peers, 
who shall give a turn to all the questions that 
affect the public health in such a manner that our 
legislation may reflect the best medical science of 
the State. We cannot believe that the coming 
medical man can ever be a partisan, but there are 
higher politics in which he will, perhaps, take much 
more part than the physician is now able to do. 



100 THE COMING MEDICAL MAN, 

The English profession live in a much older civili- 
zation than ours, and they are becoming very 
strenuous for more thorough medical representa- 
tion in the cabinet and legislature. Our needs are 
certain to be, if they are not already, the same as 
those of the country from which we in such large 
measure spring. Is it not probable that there will 
be one day a bureau or department of sanitary 
science, where now is rapidly forming one of the 
best of pathological museums, and one of the larg- 
est of medical Hbraries? 

There are quite often questions arising in medi- 
cal jurisprudence, that would be better settled by 
medical jurors than any other. Such a one was 
the famous trial that lately agitated the empire of 
Great Britain, when an impostor laid claim to an 
enormous estate by claiming to be a man to whom 
he had very little physical resemblance. Thou- 
sands of pounds were expended, a great popular 
ferment was caused, a jury was kept from their 
ordinary pursuits in life, for an almost unparalleled 
period of time, in the discussion of questions of 
identity that ought to have been settled by ex- 
perts. As suggested by the English medical 
authorities (Guy and Ferrier), a preliminary exami- 
nation of the body of the claimant would have 
soon determined whether it was possibly that of 
Roger Tichborne. There was only a period of 



THE COMING MEDICAL MAN. 10 1 

twelve years between the time of the supposed 
death of the eccentric baronet and the appearance 
of the pretender, and, as he was twenty-five years 
old when last seen, it would certainly have been 
possible for a medical commission to have soon 
settled a question of identity. 

We may congratulate ourselves that the disposi- 
tion to seek the aid of medical experts is every day 
becoming more pronounced, and that in this respect 
also our functions will certainly be greatly enlarged. 

In concluding this sketch of what we may hope 
will be some of the enlarged duties of the medical 
man of the future, I may perhaps be pardoned for 
a brief reference to what our profession has done 
for the State outside of the direct line of duty. I 
speak not of mere tyros in medicine, who have 
hastily shaken off the cares of one calling to assume 
another, or of those who bore the title of doctor as 
an honorary one, while their chief interests were in 
another direction than that of the care of the sick ; 
but of those who, after giving years of successful 
work to the every-day duties of their calling, turned 
aside from the watching of fevers and the adjust- 
ment of fractures, and, like Cincinnatus and Put- 
nam, left the implements of labor where they were 
found by the messenger who came to call them to 
their country's aid. 

Among the signers of the Declaration that led 



102 THE COMING MEDICAL MAN. 

to our becoming an independent nation, and also 
among the active members of the first Continental 
Congress, is found the name of Benjamin Rush, 
one still honored and quoted wherever medical 
science is studied. At Princeton, in the struggle 
about Nassau Hall, General Hugh Mercer, who had 
already won honor and fame as a practitioner of 
medicine, fell in battle. It was a physician also, 
and one who was the progenitor of a line of dis- 
tinguished surgeons, who led our forefathers at 
Bunker Hill. In the direct line of duty, in the 
great contest through which our country has lately 
passed, there were hundreds of medical men, who 
endured all the hardships of camp, and all the 
dangers of the battle-field, by the side of their 
brethren of the line, with no idea of the rewards 
that were the hope of those who served their 
country under no greater danger and with no 
more devotion. 

We may hope, however, that these occasions for 
service to the State are passed forever, and that we 
shall never be called from the sick-room, the labo 
ratory, and the hospital-ward, to any other duties 
to it, than the regulation and management of the 
sanitary work of the government. Yet we may 
claim, that, in all relations, our profession has de- 
served well of the republic, and I beheve we may 
look forward to a day when the duties of the phys- 



THE COMING MEDICAL MAN, IO3 

ician to his individual patients, to the pubh'c at 
large, and to the State, will be performed under 
better facilities, and with greater appreciation and 
success — to a time when a higher position, as one 
of the educated and responsible classes, will be 
taken by the medical man. 



HUMAN EYES 



IV. 

HUMAN EYES.* 

The doctrines taught in many quarters with ref- 
erence to the use, or rather the non-use of spec- 
tacles, are the same that are promulgated through 
the advertising columns of the daily press, and in 
the street placards of charlatans, who claim to pre- 
serve vision without the aid of spectacles. Venders 
of so-called eye-cups, wonder-working, self-consti- 
tuted doctors of medicine, have tried to teach us 
that the use of spectacles is a delusion and a snare. 
Very many sensible persons are actually afraid to 
wear glasses when they are needed. The following 
paper is intended to show them their error in hav- 
ing such a fear. 

We shall attempt to show, to those who have 
no time for physiological or optical studies, that 
such opinions are at variance with the accepted 
views of all those who have any claim to authority 
in the matter of the refraction and accommoda- 

* This paper was originally written in answer to an article that 
appeared in " Hours at Home." In revising it for the present pub- 
lication, those changes have been made which were necessary to take 
away any suggestion of individual controversy. 



I08 HUMAN EYES. 

tion of the eye, on a study of which, and on that 
alone, the knowledge of the proper use of specta- 
cles must depend. 

It may be necessary to remind the reader, that 
by the refraction of the eye, we understand its 
power of breaking up the rays of light which enter 
through the cornea and pupil, and of thus causing 
them to unite in a focus on the retina. By the 
accommodation of the eye, we mean the function 
by which we adapt our eyes for vision at different 
distances ; that function which enables us for exam- 
ple, to look for one instant at the printed page 
before us, and the next at the face of a friend, or 
upon a landscape. 

The anatomical structure of the eye-ball, which 
must of necessity determine its refractive power, 
as well as the function of accommodating the eye 
for vision at different distances, have been the ob- 
jects of earnest study for centuries. Pliny, Pytha 
goras, Plato, Euclid, Galen and Bacon, discoursed 
on vision, and each left the subject enriched by 
his investigations. The physiologists of the 19th 
century have been particularly active in this depart- 
ment. Their acquisitions have been so great, that 
it is now fully time that they should be made a 
part of the common stock of knowledge. 

The statements which disregard all these results 
of scientific investigation, may do much harm. 



HUMAN EYES. IO9 

Delicate persons, for whose failing power of adapt- 
ing the muscles of the eye, spectacles have been 
recommended by competent authority ; short-sighted 
persons, who " dangle lunettes at the end of a rib- 
bon ; " sexagenarians, who have been complacently 
using properly adapted lenses with great satisfac- 
tion, have become alarmed by the startling and rev- 
olutionary doctrines set before them, which but 
for their spectacles, they would have been unable 
to read. Even in the face of the comfort which 
these assistances of vision have afforded them, 
such persons are gravely asking, are these things 
so ? The writer of this, lately saw an eminent 
clergyman, somewhat advanced in years, and who 
certainly needed glasses, vainly attempting in the 
pulpit, to read his sermon without their aid, or as 
an author who has written against the use of spec- 
tacles has said, sometimes endeavoring " to cause 
the slack vessels to come up to his assistance, and 
restore the original focal distance." He only suc- 
ceeded however, in annoying his congregation and 
spoiling a good sermon, in attempting to do a 
thing as impracticable as the famous scientific ex- 
periment of lifting one's self by the waist-band of 
the trowsers. 

It is stated that the man who has not yet put 
on glasses never need do so. This declaration is 
in direct opposition to the views of all the phys- 



no HUMAN EYES. 

iologists and students of optics in the world who 
have any reputation whatever. Either they have 
made, and are continuing to make, grievous errors 
in their practical deductions from the physiology 
of vision, and the writer from whom I have just 
quoted has been the person upon whom the dis- 
tinguished honor has come of overthrowing all 
these, by a few strokes of the pen, or absolute 
and absurd error has been taught by the latter, 
and scattered broadcast among the intelligent 
classes of our land. There is no middle line. If 
this distinguished author is right, all the modern 
physiologists and ophthalmologists, on both sides 
of the Atlantic, are wrong. If he is right, it would 
be better for them to desert their laboratories and 
consulting-rooms at once, than to go on in the 
propagation of such monstrous error, as that now 
taught by them, namely, that spectacles properly 
adapted are of inestimable value. 

One writer, after a phillipic against the use of 
glasses to improve the sight, tell us that this is 
a spectacle age, and that there is a fashionable 
proneness to look through glasses of some sort ; 
" were they $500 a pair, and only attainable by 
persons of wealth," he continues, *' there would be 
more quiet eyes, and far less occupation for oculists 
— a profession that came into existence with eye- 
glasses." 



HUMAN EYES. Ill 

An English writer, about three centuries ago, 
seems to have had the same task of defending the 
use of spectacles that has devolved upon the pres- 
ent writer. Their use was then in its infancy, and 
those who attributed their action to evil spirits 
were perhaps to be pardoned. The Englishman 
says, " Great talk there is of a glass made at Ox- 
ford, in which men might see things that were 
done by evil spirits. But I know the reason to be 
good and natural, and to be aright by geometry." 
Lord Bacon, also, not having a vision of the new 
physiology to warn him from indulging a hope that 
spectacles might be a boon to humanity, says , 
" This instrument, a plane, convex glass, is useful 
to old men, and to those that have weak eyes, for 
they may see the smallest letters sufficiently mag- 
nified." In 1299, not a great while after specta- 
cles were invented, an author, whose works only 
exist in manuscript, also says, " I find myself so 
pressed by age, that I can neither read nor write 
without those glasses they call spectacles, lately 
invented to the great advantage of poor old men, 
when their sight grows weak." In a sermon of an 
Itahan friar who died in 131 1, the following passage 
occurs : " It is not twenty years since the art of 
making spectacles was found out, and is indeed 
one of the best and most necessary inventions of 
the world." On the tomb of Salvinus Amatus, 



112 HUMAN EYES, 

also an Italian, who died in 13 17, is inscribed "the 
inventor of spectacles." 

Such are the indications which history gives us 
of the high esteem with which spectacles were re- 
garded in the infancy of their use. Yet 500 years 
later there are writers who say that they are un- 
necessary and harmful, and that their invention was 
no advance at all, but a step that took us away 
from the halcyon period, when " like wild and 
domesticated animals, birds and reptiles, man re- 
tired with the shades of evening, and opened his 
eyelids in the morning as the light gradually ap- 
proaches." It is certainly correct to assume that 
if men were such animals, and made no more 
demands upon their eye-sight than birds and rep- 
tiles, they would need no spectacles. Inasmuch, 
however, as they are men, and wish to read and 
write, it is possible that they may require them, 
the new physiology to the contrary notwithstanding. 

The reasons which require so much use of spec 
tacles in this age are obvious. Great demands are 
made upon eyes and vision by the multifarious 
employments of a civilized and cultured people. 
Digger Indians and Hottentots do not need spec- 
tacles. They are not required to use their vision 
for close work and small objects. The inhabitants 
of civilized lands however must thus use their eyes, 
or not fill up the full measure of their existence. 



HUMAN EYES. 113 

It is true that the employments of this age cause 
other diseases than those prevailing in savage and 
barbarous times. Some of the conditions of the 
eye-ball, making spectacles indispensable, are thus 
produced. But the reflecting mind can scarcely im- 
agine this to be any cause for the rejection of their 
aid. As well might the patient refuse a tonic, be- 
cause he has become debilitated from excessive 
work and activity, or deny himself carefully chosen 
and well cooked food, because his civilized culture 
prevents him from eating like a savage. Spectacles 
are one of the great gifts of God, with which to 
counteract the effects of disease and advancing 
years. 

The eyes which require spectacles may be di- 
vided into four classes: — 

I. The far-sighted eye of old age. 2. The near- 
sighted eye, or the eye that is too long. 3. The 
far-sighted eye of youth, or the eye that is too 
short. 4. The weak eye, or the eye that has been 
injured by over work. 

This classification is no artificial one. It does 
not depend on fashion, or the mere dogmatic asser- 
tion of medical theorists, but on anatomical struc- 
ture, and physiological action, as determined by 
accurate investigation and experience. 

Before discussing these various conditions in 
their order, let me state that all the eyes for which 



1 14 HUMAN E YES. 

spectacles are required cannot be placed under these 
heads, but, in order to avoid undue prolixity and 
complication of the subject, I have preferred to omit 
any remarks on the less important classes, or at 
least to defer them^ until the close of the article. 

While we are indebted to a long line of scienti- 
fic worthies for the gradual progress, which has 
finally enabled us to discriminate as to the kind of 
spectacles which should be worn in different cases, 
to Dr. F. C. Bonders, Professor of Physiology in 
the University of Utrecht, belongs the honor of 
having arranged the whole subject, enriched by 
very many of his own investigations, in an harmo- 
nious whole. His great work on the Refraction 
and Accommodation of the Eye, was first written 
in the Dutch language, but it has been translated 
into the English and German, and is everywhere 
recognized as the highest authority on the subject 
of which it treats. The views that are here pre- 
sented are mainly derived from this work. 

I. The eye of old age requires spectacles. Not 
because the cornea — the anterior transparent coat of 
the eye — becomes flattened in old age, as is often 
said, nor for the reason given by another writer, 
who says, that the loss of vision depends upon a 
diminished activity of the secreting vessels, but be- 
cause a httle muscle within the eye-ball, called by 
anatomists, the ciliary muscle, loses some of its 



HUMAN E YES, 1 1 5 

power as old age comes on. This little muscle 
passes around the eye-ball, connecting the cornea 
and iris to the choroid coat, and to the ligament, 
which holds the lens in position. The vigor or 
tone of this muscle becomes impaired with advanc- 
ing years. Its ordinary work is that of making the 
lens of the eye thicker than it is when the eye is in 
a state of rest. The rays of light coming from a 
near 6bject, from the page we are now reading, for 
instance, have a divergent course, they are con- 
tinually going away from each other ; when they 
come from an object much further off they are 
parallel, or nearly so. Thus the rays from the 
music on the piano, do not come to the eye of 
the player as divergently as those from her sew- 
ing, which is held nearer than the music, and 
the further the object is removed the less divei-g- 
ent, the nearer parallel the rays become. In every 
act of changing our gaze from a remote object to 
a near one, in other words, during the act of ac- 
commodating the vision for a near object, the 
lens of the eye becomes thicker: it must then be 
relaxed, become thinner, in turning one's eyes 
from an object near at hand to one that is far 
removed. The lens also loses some of its natural 
elasticity with advancing age. It can no longer 
undergo this alternate change with the same readi- 
ness as in vouth. 



Ii6 



HUMAN EYES. 



Thus we have two factors, both acting within, 
and not without the eye-ball, that impair the 
adjusting power of the eye. No eye-cups to 
lengthen the ball, no process of straining upon the 
eye, will ever be of any but the most harmful 
assistance in attempting to overcome these natural 
and senile changes. The small object which the 
man of fifty desires to see, is held further off than 
when he was thirty because he can then have the 
benefit of rays of light that are less divergent 
than those coming from it when it is very near 
him. They will then of course not require so 
thick a lens to unite them in a distinct image 
upon the retina. The little enfeebled ciliary muscle 
will not be required to do as much work. That 
work has been constantly done, except during 
sleep, ever since our baby eyes began to look 
wonderingly from the rattle to mamma's face. 
As we turned from the book we were reading to 
the landscape before us, in all the multifarious 
employments of life which require a different line 
of vision, the ciliary muscle has become alternately 
tense and relaxed, the lens increased and lessened 
in size. The vigor of the muscle is at last im- 
paired, the faithful servant has become feeble with 
age. The great invention of spectacles is now 
made available to restore the lost equilibrium. 
There is not enough power for the work de- 



HUMAN EYES. WJ 

manded. A double convex lens, just such an one 
in shape as the one inside the eye is placed 
outside of it, in front of it, in a spectacle frame. 
The lens within the eye is thus practically made 
thicker, and the book may be held at the old 
and proper distance. Perhaps the reader has some- 
times wondered why old persons lift up or remove 
their spectacles when they turn from a book or 
newspaper to the face of some one with whom 
they wish to converse. By remembering what has 
been said above, about the rays of light being 
the less divergent, the further off the object from 
which they come, and that the lens requires to be 
made thicker in proportion to the nearness of the 
object, this will be easily understood. These views 
rest upon accurate and experimental investigation. 

Among other absurd advice given by those 
who have a horror of spectacles is that whicn 
I now quote literally. " Persist in holding the 
book in the old form of vision," whatever that 
may mean, "until the slack vessels come up to 
the assistance, in reestablishing the original focal 
distance," which will, in accordance with the new 
physiology, " even if under perplexing disadvan- 
tages" be finally achieved. The attempt of the 
economist run mad to bring his horse to live 
without eating, by gradually diminishing his food 
until he was brought down to one oat per diem, 



Il8 HUMAN EYES. 

was quite as successful as will be any attempt to 
rejuvenate a muscle and a lens, which have become 
senile from the same natural but inexorable laws 
that cause all the powers of man to decay. 

The view that those who have not yet worn 
spectacles need not put them on, is sustained by 
a reference to the cases seen in every circle of 
individuals, where old people read without glasses. 
Here again the true explanation of a natural state 
of things has been quietly ignored. The old people 
who are to be seen working without glasses, were 
born with an eye-ball which is too long. The 
senile changes which tend to shorten the eye, are 
thus counterbalanced or neutralized by the con- 
genital malformation. This is probably the ex- 
planation of such cases as those of Cicero, Hum- 
boldt, and John Quincy Adams, which were 
adduced by one author. Professor Bonders remarks 
that the most useful eye is one that is somewhat 
short-sighted, for the reason that in advanced life 
glasses need not be used for reading and writing, 
by such persons. These subjects are apt to boast 
of the superiority of their eye-sight over that of 
their neighbors. If we place a weak, concave lens 
before their eye, we can soon convince them, 
that they can see objects at a distance better 
with than without its aid. The superiority of their 
vision, then, is limited to near objects. 



HUMAN EYES. II9 

The remarks that have as yet been made in 
this article refer chiefly to the eye of old age. 
I will now go on and speak of the reasons for the 
use of spectacles in the case of young people. 

2. Short-sighted eyes, or those which are too 
long from before backward, require spectacles. 
This is a congenital condition, sometimes inherited. 
It is more common in Germany, probably, than in 
any o/ther country. Undoubtedly, if generation 
after generation overwork their eyes, and under 
improper conditions of light and character of type, 
a race of near-sighted people will be at last 
produced. This has occurred in the cultivated 
classes in Germany, and it is occurring in this 
country. 

When once existing, short-sightedness is apt to 
increase, if great care be not taken in preventing 
those who are its subjects, from too prolonged 
use of the eyes, with the head greatly bent over 
toward the work, or with an improper or insufficient 
illumination of the objects looked upon. Great 
care should therefore be taken in arranging school- 
desks and the like, in order that short-sighted 
children may not become more so. The late 
Horace Greeley with a practical sagacity that was 
characteristic, was at great pains to save his short 
sighted eyes by writing at a high desk. 

Short-sighted persons do not usually need 



120 HUMAN EYES. 

glasses, for reading or writing, for the very simple 
reason that divergent rays of light are easily 
brought to a focus on a retina, which is situated 
further back than it should be. Very little tension 
is required of their muscle of accommodation in 
uniting those rays. But in looking at a distance, 
when the rays of light which strike the eye are 
parallel, they have trouble. Do what they will, 
they cannot unite such rays on a distinct image 
on the retina. They unite in front of it. The 
reader will remember that his short-sighted friends 
cannot read signs, they do not know their friends 
on the other side of the street, in short they do 
not see things that are somewhat removed unless 
they have their glasses on. 

A concave lens, as we all know, disperses rays 
of Hght, producing just the opposite effect of a 
convex one, which collects them. Parallel rays 
are thus changed into those that are divergent. 
When a concave lens is placed before the eye, 
the eye-ball is in effect shortened, made to ap- 
proximate one of the proper length. Any one who 
has normal eyes, who would like to know how 
indistinctly short-sighted persons see objects at a 
distance without concave glasses, should step into 
an optician's, and put himself in their position, 
by putting on convex glasses, which will make 
his eye too long. He may, after doing this, also 



HUMAN EYES. 121 

experience the gratification of a short-sighted 
person, when he puts on correcting spectacles, and 
looks out on a world of beauty, which he sees 
distinctly for the first time. This latter will be 
done by neutrahzing the convex glasses by concave 
ones of the same focal distance. The experimenter 
has thus done what the oculist does for a short- 
sighted) patient. The effect that is produced is 
purely mechanical, both in the eye naturally short- 
sighted and the one artificially made so. 

So far from the use of proper glasses being an 
injury to such patients, they are a positive benefit. 
A neglect to wear spectacles when the circum- 
stances require them, besides depriving a person of 
perfect vision, may have other serious consequences. 
It is doubtful if a short-sighted boy who has 
been unable to be a peer with his fellows, because 
his lack of vision has rendered him unable to 
fully participate in the sports of childhood can 
ever be properly and symmetrically developed in 
character. Bonders and Loring have called par- 
ticular attention to this result of uncorrected 
myopia. The short-sighted eye is also essentially 
a diseased eye and requires great care in its 
management ; but spectacles rightly used assist in 
preserving its functions. It may be said to be 
diseased because it has been elongated by undue 
pressure from within. Dr. Edward T. Ely has 



122 HUMAN EYES. 

shown that a very small proportion of the newly- 
born are myopic. 

3. Eyes that are congenitally too short require 
glasses. This state of arrested development in- 
cludes quite a large proportion of human eyes. 
We may rejoice, however, that we now know 
that in the scientific use of convex glasses, we 
have found a means of alleviating this condition. 
Until Professor Bonders discovered the anatomical 
condition at the basis of the want of vision of 
this class, their fate was truly horrible. They were 
deemed to be unfortunates who had the eyes of 
old people, but to whom it was dangerous to give 
glasses ; or still worse, they were considered as 
victims of incipient blindness, which could only be 
guarded off by the most vigorous anti-inflammatory 
regimen. Such patients were often confined to 
darkened rooms, cupped, blistered, and salivated : 
in short, they were in many instances, the victims 
of actual martyrdom. The only source of relief, 
that is, the use of convex glasses, was absolutely 
prohibited lest the weakness of sight should end 
in complete blindness. 

The genius of Helmholtz, the inventor of the 
instrument by which the interior of the eye is 
examined, has enabled us to detect the structural 
abnormity which renders this class unable to see 
well at any distance, unless aided by glasses. By 



HUMAN EYES. 1 23 

means of the ophthalmoscope, 01 eye-mirror, if 
the cornea, lens and the vitreous humor be trans- 
parent, the back of the eye, where the optic 
nerve enters from the brain, may be as clearly seen, 
— to use a homely phrase — as the nose on a 
man's face. Besides this, the refractive power of 
the eye can be accurately determined by the 
same instrument. It was found by the ophthalmo- 
scope that this class of eyes, now under considera- 
tion, were too short. Hence, both divergent and 
parallel rays would only come to a focus or unite 
behind the retina. The loss or indistinctness of 
sight, was explained. In convex glasses, which 
make an eye-ball practically longer, a remedy was 
found. There are no evil consequences to be 
feared from their use, their effect is purely 
mechanical, and prevents rather than causes trouble, 
improves the sight and assists in the development 
of character, just as we have seen is the case in 
the use of glasses for short-sightedness. 

If glasses are not worn by persons who are 
born with eye-balls that are too short, two un- 
pleasant results occur. One is that they cannot 
see distinctty ; another that many such persons 
at last learn to deviate or squint one eye inward 
perhaps in order to see more distinctly with the 
one which they direct upon the object of vision. 
A large proportion of the causes of " cross-eye," 



124 HUMAN EYES. 

which we see in the streets, result from a non- 
use of glasses, by these congenitally far-sighted 
persons. An accurate examination of the squint- 
ing eye will often show that distinct images are 
not formed upon it — in fact such persons are half 
blind of one eye. It is believed by some author- 
ities that this loss of vision is due to disuse of 
the squinting or deviating eye. Certainly the 
proper use of spectacles is a great boon to such 
eyes. 

4. Eyes whose muscles have been injured by 
over-work, often require glasses. Glasses are often 
used in this class of cases to provoke gymnastic 
exercise on the part of the internal muscle of the 
eye, or to take off part of the effort required 
of a debilitated muscle. They become a direct 
means of cure. They enable the patient to 
enjoy a moderate use of his eyes, at the same 
time that the general treatment adapted to their 
diseased condition is going on. This is certainly 
a great advance, when we consider that patients 
with a weakness of the eyes, that did not de- 
pend upon organic change, were formerly con- 
demned to absolute disuse of the organ of vision 
for months and even years. 

The writer of the present article had occasion 
not very long since, in the case of a member of 
his own family, to consider the great blessing of 



HUMAN EYES. 1 25 

Spectacles to one who had over-taxed, or over- 
tired the eyes. Under the old regime, this patient 
would have been compelled to fold her arms and 
do nothing. If medical tortures were not added 
to this wearisome inactivity she would have been 
fortunate. Taking advantage of recent investiga- 
tions, glasses were adjusted which enabled the pati- 
ent in a few days to read a very considerable time 
at different periods, until finally, by the combina- 
tion of proper general treatment, with this local and 
pleasant means, the lost tone of the ocular muscles 
was restored, while the patient had passed through 
but few days during which the eyes were not 
occupied on close work. 

I will now conclude this paper by stating that 
some eyes come into the world of such an irreg- 
ular shape that they may be too long in one merid- 
ian, and too short in another, or both meridians 
may be too short or vice versa. This state of 
things is called astigmatism and it also may be 
corrected by a glass ground from a cylinder in- 
stead of from a sphere. Astigmatism probably pro- 
duces the most troublesome form of impaired 
sight, and its existence is often unsuspected. Its 
chief symptom is the inability to see vertical and 
horizontal lines at the same distance. 

We must content ourselves with these hints 
which it is hoped will serve to correct the errors 



126 HUMAN EYES. 

of those who beHeve that there is harm in im- 
proving sight by glasses. 

The results attained by the use of spectacles 
for human eyes are laurels entwined about the 
brow of modern physiology. No hand can tear 
them away. They are the insignia of centuries 
of struggle on the field of science. 

These achievements are destined still to be 
amplified and repeated in the advance of human 
knowledge. They who advise against the use of 
glasses disregard the beneficent results of centuries 
of thought and experience in the interests of 
science and humanity. These so-called modern 
innovations will continue to alleviate human imper- 
fections, and there will be fewer more worthy en- 
comiums than those to the Italian on whose tomb 
is engraved " to the inventor of spectacles." 



MAINTENANCE OF HEALTH. 



/ V. 

MAINTENANCE OF HEALTH. 

Lecture delivered before tJie students of the Union 
Theological Seminary, March 1880.* 

Mr. President, Gentlemen of the Faculty 
AND Students. 

There is no particular reason why I should 
talk to you upon the subject of the maintenance 
of your personal health except that which is 
found in the fact that twenty years ago I was 
graduated in medicine, and since that time, so far 
as my working hours are concerned, my life has 
been given to the care of the sick and ailing. 
All that is known relative to the structure and 
functions of the lungs, of the heart, of the brain, 
and other organs of the body, you can readily 
acquire from the text books on physiology. As 
educated men with trained habits of study you can 
learn this as easily as any medical student, but 
you cannot get from any book a kind of knowU 

* Reported phonographically by Dr. Wesley M, Carpenter. 



130 MAINTENANCE OF HEALTH. 

edge exactly like that obtained by a man vvho 
has been engaged for a number of years in the 
study and treatment of disease. No books can give 
this latter kind of knowledge. You will pardon me 
for saying, with the greatest respect for ministers, 
that I do not think they, as a class, fully appre- 
ciate this which I assume to be a fact. I believe 
that no man, however well educated, unless he is 
every day with the sick, either in the wards of a 
hospital or in the rooms of private patients, can 
speak with any authority in regard to disease or 
the maintenance of health. Only a man who is 
every day listening to the stories of sick people 
and whose thoughts are chiefly on the subject of 
their cure, is competent to prescribe for the re- 
lief of disease. He, only, has the experience which 
is absolutely essential to the proper performance of 
such a duty. Therefore in the beginning I remark, 
that you will make a mistake if you suppose that, 
with any knowledge you may possess or acquire 
with reference to the functions of the various or- 
gans in the body, you will be competent to ven- 
ture upon any but the most general expressions of 
opinion with regard to the treatment of disease. 
The other day 1 was called to see a gentleman 
suffering from a certain malady, and incidentally 
he told me that he employed all his leisure time 
in a little workshop, where he turned out minia- 



MAINTEXAXCE OF HEALTH. I3I 



ture steam engines and toys of like charactei. 
That man may have learned a good deal about 
steam engines, even how to build one in a sim- 
ple way, in the leisure moments he can spare 
from his duties as a down-town business man ; but 
no matter how complete his machinery might ap- 
pear in miniature, neither you nor I would be will- 
ing to cross the ocean in a steamship whose engines 
were to be managed by him alone. The mo- 
ment that the practical functions of an engineer 
are given to such a man you go entirely beyond 
his competency for safe and skillful action. 

It is not your province to prescribe for the 
sick except in the direst emergencies, when your 
trained minds and good common sense perhaps 
will be of more practical value than any that can 
be offered by ignorant people who may be under 
your care. It is not safe for any man to formu- 
late opinions as to the treatm.ent of disease, even 
from a somewhat exact knowledge of the anatomy 
and physiolog}^ of the human body. You will 
often hear it said that medicine is an inexact 
science. So it is, but this inexactness refers chiefly 
to our prescribing for disease, and the safest 
thing to be done is to obtain the assistance of 
the best and most extensive experience. This in- 
exactness of our science is one of the reasons 
why it is so dangerous for men with limited 



132 MAINTENANCE OF HEALTH. 

knowledge and still more limited experience, to 
venture upon opinions which may lead their fellow- 
men into serious consequences. I have said all 
this, lest it might be supposed that the object of 
these lectures upon the maintenance of health 
was to teach you to dispense with physicians or 
to enable you to prescribe for yourselves when 
disease has attacked your bodies. 

When the Apostle Paul speaks of the body as 
the temple of the Holy Spirit, he has certainly 
given it a very high place, and has dignified it 
beyond any expression of ours. I propose to talk 
to you this afternoon with reference to some 
points pertaining to the care of that temple. 

The brain is the part of the body which men 
of your calling think most of, perhaps, when they 
think of their physical organism, but it is possible 
that you do not realize, at least as you should, 
that good care of the brain, is always of necessity 
founded upon good care of the general system. 
Where shall I better begin in giving any ideas 
about the good care of the general system than 
with the proper management of the skin ? There 
are many doctrines with regard to the treatment 
of the coverings of the body, but I think when 
they are carefully considered you will find there is 
no very great difference in opinion among those 
people who have reached the highest point in 



MAINTENANCE OF HEALTH. 1 33 

civilization and at the present day hold the front 
rank among the nations. You know a Spanish 
proverb is that " the man of many baths is short 
lived." There is a distinguished German professor 
of diseases of the skin, who says that the English 
people are ruining themselves by frequent bathing. 
Now you and I are perfectly willing to compare, 
from a sanitary standpoint, the English with the 
Spaniards or the Germans, in fact with the people 
of any nation upon the face of the earth. Speak- 
ing as a medical man, and from a medical 
standpoint, the English nation may be regarded 
as the best representative of a people with sound 
minds in sound bodies, and perhaps their bath- 
ing habits have had something to do with their 
present good physical condition as a race. If in 
America we are following close upon them in our 
devotion to water and bathing, I think we are 
following them in exactly the right way. The 
man of average health should have a complete 
bath once every day. There are exceptions to 
this rule. Men who are chronic invalids, who were 
born with a physical inheritance that they can 
no more throw off than they can their moral 
natures, must be treated more tenderly than a 
daily bath implies. I know how difficult it is to 
manage this when a student has only one room, as 
is usually the case with young men in college, and 



134 MAINTENANCE OF HEALTH. 

perhaps with a fire that is only very temporary and 
is suppHed by wood which he himself brings from 
the yard ; but I say, as a rule a man should have 
a daily bath. It does not take much water, and 
it is not for cleansing purposes entirely that a man 
needs a daily bath. I suppose that in the winter 
season, the man who washes the unexposed parts of 
his body thoroughly with soap and water twice a 
week is a tolerably clean man. But bathing is not 
solely for the sake of cleanHness of the skin ; the 
grooming and friction that follow the bath are nec- 
essary to prevent a man from taking cold. When a 
man takes cold upon the least exposure, when he is 
conscious the first instant he enters a room that its 
temperature is not exactly right, there is something 
the matter with him. He is not well. The daily 
bath keeps the skin, with its miles of tubes filled 
with oily material, — there is no exaggeration in that 
statement, — in such a condition that its blood ves- 
sels will act in an instant to regulate the heat of 
the parts so that when the man goes from one 
temperature to another he will not feel the change 
for some time. Professor Hitchcock asks if there 
is any choice between morning and evening as to 
when the daily bath should be taken. I think there 
is. I think a man who has eight or ten hours of 
sleep should be bathed in the morning, especially 
if he sleeps in a room which is closer than that in 



MAINTENANCE OF HEALTH. 1 35 

which he pursues his oaily avocation. If but one 
bath daily can be taken, it should be in the morn- 
ing. If the bather is a dehcate man, it is prefer- 
able that he should take his bath in the morning, 
and the bath sh^ould not be cold, but iuke-warm. 
If it is a very warm or hot bath, it should, as a 
rule be in the evening, because it is not quite safe 
to relax the system with warm water and then go 
out into the open air. If you are stalwart a cold 
bath may be taken in winter as well as summer. 
But you cannot harden yourselves by bathing, to 
any such extent that a dehcate man, perhaps 
under-sized, perhaps with limited space for his 
lungs to expand in, who perhaps began his studies 
in badly ventilated rooms and burned freely of 
the midnight oil, can take a full cold bath with 
safety. He may be able to take a cold sponge 
bath. I think the feet should be washed twice a 
day under all ordinary circumstances. Now, the 
man who keeps his skin in this condition will find 
that he is started well in the way of preventing dis- 
eases of the kidneys, which as you already know are 
the waste pipes of the body, and also oi prevent- 
ing disease of the brain. 

A few words concerning Turkish and Russian 
baths. When these are given to invahds they 
should be taken only under medical directions. They 
are extremely useful, but they will not work mira- 



13^ MAINTENANCE OF HEALTH. 

cles. The Turkish bath, no matter how rigorously 
taken, will not allow a man to live under im- 
proper hygienic conditions or to indulge in ex- 
cesses all the week hoping that Saturday's bath 
will bring him up fresh for Monday. The Russian 
bath is more dangerous than the Turkish. The 
term danger can be applied to a system of bath- 
ing as well as to anything else. But both are to 
be taken only under medical advice. The advice 
received at the bath-rooms is not always of an 
unprejudiced character. 

With regard to brain work and bodily exercise. 
Charles Dickens thought he could undo all the 
consequences of his excessive brain work by ex- 
cessive physical exercise. I find many men, phy- 
sicians and learned ministers, making, as it seems 
to me, the same mistake. Dickens sometimes 
walked from Gad's Hill into London, a distance of 
about twenty-five miles, after he had done excessive 
brain work. Now, to walk twenty-five miles is 
nothing for a man in good vigor who has not 
spent many hours just before the walk in active 
exercise of his brain, but for a man who has 
been composing such books as David Copperfield, 
working with all the intentness which such a 
work implies and worn by mental fatigue, such 
physical exercise is very exhausting. No man 
should take severe bodily exercise such as that 



MAINTENANCE OF HEALTH. 13/ 

involved in reaching a certain point in a given 
length of time, or undergo great muscular exer- 
tion, when he is severely fatigued with mental 
labor. I do not rr^ean when he is wearied simply 
by listening not always too intently, but when he 
is actually tired out from such mental work as 
grappling with commentaries and lexicons, or per- 
haps with the subject-matter of a sermon. After 
this he cannot immediately restore his vigor by 
rushing out and taking a horseback ride or by 
pulling at the oars. What such a person needs 
is some gentle exercise like walking at a moderate 
pace, and if possible with pleasant surroundings. 
But that exercise should be gentle, it should be 
that which will not cause the circulation of the 
blood to be very rapid. All your professors and 
all students know perfectly well that the feet 
are apt to become cold while they are engaged 
in studying or writing upon a profound or anxious 
subject. When such a change has been taking 
place in the body, it is not a wise plan to 
go out and undertake any very serious muscular 
exertion which involves rapid change in the cir- 
culation. I now speak from the experience of 
a physician, of one who has himself come from 
a delicate youth to a vigorous manhood. I think 
the best thing you can do after such prolonged 
exertion, if the weather is inviting, is to take 



138 MAINTENANCE OF HEALTH. 

a gentle walk or a drive. If in the country 
you may fish or hunt, but if not situated so 
as to be able to take these or kindred exercises, 
the best thing is to lie down for a half hour 
in a well ventilated room and with sufficient 
covering to prevent you from taking cold. After 
such a rest you may start out for a more vigor- 
ous exercise, or you may have days of complete 
recreation out of doors. 

The gymnasium has a great reputation among 
college students and a great many patients and 
young men in the city of New York think it a 
very proper place to obtain healthful exercise. I 
do not know whether my friends who are athletes 
will regard me as orthodox in what I shall say, 
but I do not know what a professional man who 
has an enormous muscle does with it. I do not 
think a professional man needs to do many things 
with muscles except to take long walks, ride on 
horseback, and fish and hunt a little, and I do 
not have that belief in gynnasiums which I think 
many men have. The exercise taken in a gym- 
nasium is taken in confined air. It may do very 
well for men who live all day long in well ven- 
tilated offices, but for men like yourselves who in 
your college and seminary life spend many hours 
in company with others, and perhaps in poisoned 
air, I do not believe the gymnasium is, as a rule, 



MAINTENANCE OF HEALTH, 1 39 

the place for you to recuperate. A small amount of 
gymnastic exercise may be done undoubtedly with- 
out harm if you have a special wish to cultivate 
a powerful biceps, but there is no great advantage 
in being able to wield a blacksmith's hammer a 
certain length of time without muscular tire, unless 
you are a blacksmith by occupation. We forget 
sometimes that the varieties of childhood's avoca- 
tions and of early youth provide a man with 
about all the muscle he will need for his future 
use. There is no particular virtue in having a 
big muscle. It is a grand thing to be intellectually 
a well developed man, but there is nothing in the 
development of one's biceps out of all proportion 
to the rest of the body that is ennobling. Such 
an unsymmetrical development is not quite in keep- 
ing with good physical development unless it is 
actually necessary for the discharge of the duties 
of one's avocations. There is no necessity for it 
in this civilized land, and I do not beheve that 
gymnastic exercise is to be specially commended. 
I would much prefer military drill, or riding after 
the hounds, or shooting with a good dog. An- 
other objection against gymnastics is that the 
temptation to take dangerous exercise is very 
great. I have already lived sufficiently long to 
know several men who have fallen the victims of 
excessive exercise in gymnasiums. These places are 



140 MAINTENANCE OF HEALTH. 

not always under proper medical directions. Cer- 
tainly the director should be a man who has 
medical knowledge. 

I understand that all members of this seminary 
are educated men already, and in that respect you 
have great advantage over many medical students, 
for medical students are not graduates of colleges 
in nearly so large proportion as are theological 
students of this church. You, with minds already 
trained to habits of study, know what to do, in 
order while studying, to get the most out of your 
mental labor within a limited number of hours. 
But I am consulted by such men as you, and I 
am obliged to find out how they live, where the 
faults are in their mode of living, in order to give 
them rational advice. Hence I may venture to 
say a word or two upon the subject on which you- 
are experts. A great deal of credit has been given 
to midnight oil, and I have no doubt that it has 
been brilHant enough to make a great many men 
do good work by it, yet I think that most of the 
best mental work is done in the morning, and 
after a man has had his breakfast. I remember 
to have read that Albert Barnes wrote a great por- 
tion of his " Notes on the Gospels " before breakfast. 
Dr. Adams reminds me that he wrote all of that 
most wonderful work before breakfast, but this is 
an exception to the common rule. I believe that 



MAINTENANCE OF HEALTH. I4I 

most men should take a cup of coffee or a glass of 
milk, whichever they may be accustomed to, before 
beginning any intellectual work in the morning. 
Very few persons can long continue to do good 
work on an entirely empty stomach. A doctor in 
practice, different from ministers, must read and 
write books as he can. You have a choice of hours, 
and can have either an early breakfast or take a cup 
of coffee, a glass of milk, or a crust of bread. But 
work while you work, and when you get through 
do not dawdle in your library all the morning. 
You had better be in the woods or fields after 
earnest mental labor. Many complaints of ill feel- 
ing in the head result not from very hard work in 
the library, but from lazily reading in an impure 
and perhaps tobacco-laden air. Give your best 
hours, those just after a refreshing sleep, to the pre- 
paration of your sermons. Sermons are the things 
which do the congregation the most good. At all 
events the sermons are what we of the laity rely 
upon, as guides to our spiritual welfare and knowl- 
edge of the Scriptures. At other times you may 
make or receive pastoral calls, listen to the gossip 
of the old ladies, or dandle the children, all of which 
will come within your province. You can have all 
that for recreation. 

A few words about food and feeding. There is 
an unwise dread in the world, of eating too much. 



142 MAINTENANCE OF HEALTH. 

Dr. Flint is in the habit of saying that no man 
ever died while he was able to digest food. Try- 
to eat well chosen, well cooked food. Much has 
been done in medicine in the way of refining drugs 
and when you and I are ill, we are no longer 
obliged to take the large and nauseating doses 
swallowed by our ancestors, but the refined extracts 
take the place of the gross preparation. Just so it 
is with reference to food. A true progress in civili- 
zation refines the food that we eat, while it will not 
take away any of its truly nutritive qualities. Good 
ministers should be well fed. In the days of Queen 
Elizabeth, Sir Walter Raleigh and Sir PhiHp Sid- 
ney sat down to much coarser viands than do the 
literary men of our time. We are improving in the 
preparation and quality of our food in a remark- 
able manner. Our possibilities in the way of cheap 
food are equal to those offered to any people. 

Do not allow yourselves to be interrupted dur- 
ing your meals. If you are in a country parish, 
you will be obliged to receive calls from the farmer 
or the mechanic who thinks that he must see you 
the very instant he gets into the house. It is much 
better, if you must see your visitor at once, to 
bring him in and have him share your breakfast or 
dinner, or supper, than to have him wait in the 
ante-room, you knowing that he waits impatiently 
perhaps, as he regards his business as most im- 



MAINTENANCE OF HEALTH. 1 43 

portant. Interruptions while eating are serious af- 
fairs for men whose chief -employment is brain 
work. They interfere sorely with digestion. 

. In regard to the hour for retiring. This involves 
somewhat that which I have already said as to the 
best hours for study. An early hour for retiring is 
best for men who wish to do good work. The 
early hours of the night are better than the late 
ones for resting. At the very beginning of your 
ministerial lives it is well for you to learn that you 
must give up something, and must not expect to 
be profound men upon all subjects. You cannot be 
ministers with either a small or a large parish, and 
keep pace with all that pertains to the church, with 
all that is political, and with all the general and 
scientific literature of the day. It cannot be done. 
The doctors have found that out loner aa;o. It is 
true that you have a little more command of your 
time than do physicians in active practice, but you 
must give up the opinion that you can fill all your 
spare time with reading, for it fatigues the brain 
to a greater or less degree the same as does any 
kind of mental labor. When you read politics read 
them earnestly, but do not consume your hours for 
recreation with reading that kind of literature. Do 
your general reading as a portion of your profes- 
sional work, but not as rest for the brain. 

I will conclude what I have to say this after- 



144 MAINTENANCE OF HEALTH. 

noon upon the maintenance of bodily health, with 
some reference to a vexed question. I hope you 
will bear with me, for I am to give you simply 
my own belief and the result of my experience, 
and you must take it with what grains of salt may 
be necessary. Tea, coffee, tobacco, and alcohol. 
Tea is a stimulant. It has scarcely any nutriment. 
It is very valuable in resting a jaded and wearied 
brain. A cup or two of tea is sometimes very 
useful in driving off an attack of headache. But 
one of my own family made herself a nervous 
and excitable woman by the immoderate use of tea. 
This is all the hint I can give with reference 
to the use of tea. Coffee is actually nutritious. 
Coffee in the morning is food. It is more than 
a stimulant. In moderation therefore coffee may 
be used as an article of food by a man who per- 
forms brain work mostly. As to tobacco. I think 
the opinion of the medical profession and of the 
public is quite uniform upon the question of the use 
of tobacco, and we may therefore accept that view. 
It is pretty well settled that growing . persons 
should not use tobacco. Of course we have not 
yet reached the ultimatum upon this subject, but 
it is safe to say that boys seventeen or eighteen 
years of age would be better off without than 
with tobacco. In regard to its use at a subsequent 
age, I am not going to stand here and advise 



MAINTENANCE OF HEALTH. I45 

you not to do a thing which I do myself. I 
smoke one cigar a day. I ^ould not smoke that 
one if I thought smoking was morally wrong, or 
that the one cigar injured my physical system. 
Two cigars daily is an excess for me, one I do 
not think is. Perhaps there are some for whom 
even one cigar would be an excess, and those 
persons should not take the single cigar. Tobacco 
then for growing persons I believe is unnecessary 
as a nerve stimulant and is probably harmful, but 
for persons who have reached fully developed 
manhood, when used in moderation it is probably 
not harmful, but beneficial. Tobacco chewing I 
will not speak of. There is a great deal of un- 
sound and illogical argument used against the use 
of tobacco. The other day Dr. Edward T. Ely 
of this city made a critical examination of the eye- 
sight of one hundred people who have lived in to- 
bacco all their lives and who have smoked it ex- 
cessively. They may have injured their general 
system, but that was not the subject under con- 
sideration in that examination ; so far as could be 
ascertained, not one has certainly injured his eye. 
sight by the use of and work with tobacco. I do 
not beheve that it is dangerous to tell Christian 
men hke you, facts Hke these. Tobacco is a dan- 
gerous drug, but there is no reason in that fact 
for the argument that it must everywhere and on 



140 MAINTENANCE OF HEALTH. 

every occasion be abandoned, and no man allowed 
to smoke. 

As to alcohol. You will remember what the 
Bible says, " Wine that gladdens the heart and oil 
that causeth the face of man to shine," but "strong 
drink" is to be given only *' to him who is ready to 
perish." The Bible in these texts and in the mira- 
cle at Cana gives the gist of the entire question. 
I do not believe there are any circumstances except 
in connection with disease which justify a man in 
using as a beverage rum, or gin, or brandy or 
whiskey, in other words strong drink. There are 
no conditions except those pertaining to disease 
in which their use is justified and then only by 
the aid of a medical adviser. 

Now with regard to the lighter wines and 
beer. I do not believe that any growing person, 
under any circumstances, except those pertaining 
to disease, needs either wine or beer, but with 
adults the case is different. Some of you who read 
extensively have doubtless already read the opinions 
of seven or eight learned English physicians"^ with 
regard to the use of wine and beer. Among the many 
opinions which the people have received from the 
medical profession one from Dr. B. A. Richardson, 
is most often quoted, and because the doctor recom- 
mends total abstinence from alcohol as a beverage. 

* " The Alcohol Question." 



MAINTENANCE OF HEALTH. 1 47 

As opposed to him, however, there are several of 
equal authority, who do not go so far, and while 
they do not extend their license to the use of 
strong drink, permit the use of the light wines 
and beer during meals to adults, who are engaged 
in hard mental or physical labor. This is the 
doctrine which I accept, for while I hold that 
intemperance is a sin, I cannot believe that the 
temperate use of light wines or beer is a crime. 
Nay I believe that a very moderate indulgence 
in light wine and beer, at meals, will in the vast 
majority of cases contribute to the health and 
happiness of hard working or delicate men and 
women. 

With your hearts filled with christian faith, and 
with the warnings against drunkenness, which the 
word of God so abundantly bestows, fully on your 
minds, you will have no difficulty, while you prac- 
tice the christian law of liberty, in restraining any 
tendencies to excess in that which so easily be- 
comes a mocker and a raging fire. 



MAINTENANCE OF HEALTH. 



SECOND LECTURE. 



MAINTENANCE OF HEALTH. 



Before the stude^its of the Union Theological Seminary, 

We have been lately told, with how much 
truth I do not know, that an instrument has been 
invented called the diaphone, which will enable 
a man in the old world to examine the state of 
affairs in New York by means of sunlight from 
Asia ; so that with the telephone and the dia- 
phone, a man in Liverpool may not only hear 
what his friend in New York is saying, but see 
him while he is speaking. I can neither assert 
nor deny that this discovery is a real one. Since 
a great scientist asserted that a steamship would 
never be able to cross the Atlantic Ocean, because 
it could not carry coal enough to last during 
the voyage, and fulfilled his prophesy by coming 
upon the first steamer that crossed from Liverpool 
to New York, men of a scientific turn of mind 
hesitate before they deny the possibility of any- 
thing. I made an allusion to the diaphone simply 

* Reported phonographically, by Dr. ^Yesley M. Carpenter. 



152 MAINTENANCE OF HEALTH. 

to bring to your minds what has been accomplished 
during the Hfe time of your honored President. 
The telephone, the telegraph, the railway, all, if 
I am not mistaken, have come into use since 
Dr. Adams became a grown man. 

Dr. Adams says that cheap postage may be 
added to my list. That by no means is the 
least important among modern acquisitions. All 
these things show that there is no longer a 
** cool sequestered vale " in the way of life. 

There is no longer any hamlet so obscure or 
retired that it cannot be reached by cheap post- 
age and the telegraph. These things are not to 
be underestimated in the education of mankind. 
But this is a topic for consideration by your own 
Professors, and for your own thoughts; the effects 
that these discoveries have had upon physical 
existence and upon physical health may be pro- 
perly a part of my theme. With all the good 
they have accomplished, they have also prevented 
much of the quiet of life which was once possible. 
These inventions make life very hard. No matter 
where you are settled, even if you go as mis- 
sionaries to what we call foreign lands, you will 
be followed by the remorseless telegraph or the 
frequent interruptions of cheap postage. You will 
be obliged to work much harder than your pre- 
decessor simply because of the requirements which 



MAINTENANCE OF HEALTH, 153 

have been made so numerous by modern inven- 
tions. These inventions come into play in making 
the headache and weariness which sometimes follow 
earnest, rapid, and continued intellectual exercise. 
The other day I heard a gentleman seriously 
complain that the constant use of the telephone 
had injured his brain and impaired his hearing. 
There seems to be some foundation for his con- 
viction, but it was not the telephone alone, but 
the numerous things which surrounded the tele- 
phone and made life so hurried and hard to bear, 
that were doing the evil work. 

Reflection upon this sum.mary of the progress 
of our century, and the struggle and labor con- 
sequent upon them, will naturally cause you to draw 
the conclusion that there must be frequent pauses 
in such labors. You must have vacations. T am 
pained to see the things which I have sometimes 
occasion to read even in religious papers about 
minister's vacations. Some people actually seem 
to begrudge the Pastor his time for rest. Such 
persons are to be pitied, for it must be ignorance that 
causes this begrudging. It must be a misconcep- 
tion of the hard labor which is required of a man 
who is in earnest in this work of bringing men to 
love and imitate Jesus Christ. You need rest 
from your intellectual occupation as much as the 
body needs rest from continuous physical exertion. 



154 MAINTENANCE OF HEALTH. 

Mental rest is as necessary as physical rest, and 
men habitually employed either as scholars or as 
those who are worried over the great interests of 
the church and the work of saving human souls, 
are quite as much in need of intellectual rest as 
those whose duties are to plead cases in the 
courts of law, or to manage the affairs of state. A 
vacation should be a vacation. It should be spent 
in play, manly play. 

One of your professors told me last week 
of the regret expressed by a high official and 
hard worker for our government, when he visited 
England, that he should not have been trained 
in the practice of shooting, an enjoyment and 
recreation so popular there among gentlemen of 
his profession. I have already alluded to the 
great physical strength of the English nation, 
in which regard it leads all others. One of the 
reasons of this position is that their brain workers 
regularly and systematically take vacations. They 
hunt in their own country, or visit the moors 
of Scotland, or wander beside the waterfalls of 
Norway, or climb the passes in Switzerland. No 
one objects to granting a vacation to the college 
professor, to the school boy, or to the college 
student, and the day will come when no one, not 
even a correspondent, or any writer for our papers 
will object to the minister having an honest vaca- 



MAINTENANCE OF HEALTH, 155 

tion according to his natural physical organization, 
to his necessities, his age and the amount of work 
he has to do. I knew a young minister who so 
startled a christian community because he played 
a game of base ball, that they all stood aghast. 
I felt sorry for the minister, but more sorry for 
the community that was so educated as to consider 
this young man in any manner demeaning himself 
because he joined the young people of the town 
in a manly game of base ball. 

Let me now turn to the influence of the 
mind upon the physical condition. I do not 
believe that even we, who spend all our time 
in the study of diseases, as yet fully appreciate 
the influence which mind exerts over matter. We 
have not yet begun to realize how many people 
are cured because they think they are to be cured 
and how much pluck will do in dispelling condi- 
tions of disease. When you add to natural pluck 
christian faith fully experienced, you have a con- 
dition of mind that exerts a powerful influence 
upon disease. A noted surgeon once told me 
that he preferred to operate upon a Presbyterian 
to anybody else, and I said, how is that, Doctor? 
He answered, *' because the future is all right 
with him, and he has made up his mind to what- 
ever comes. If he dies it is well, and if he re- 
covers ir is well." You see he valued a calm 



15^ MAINTENANCE OF HEALTH. 

mind as a determining factor in the result of 
an operation. Many, if not all of you may have 
read Dr. Simpson's writings regarding the death 
of our Lord. Besides much in his book that 
is very interesting, it seems to me that Dr. 
Simpson has offered a valid explanation for all 
the symptoms which are detailed with such mi- 
nuteness in the account of the death of our 
Saviour, especially the flowing out of blood and 
water when his side was pierced. It is possible 
to believe that the Lord died from rupture of the 
heart, actual rupture of the walls of the heart. 
Such a mode of death is not unknown in history 
as having been caused by great mental agony, 
at all events, whether the theory is correct or 
not, the influence which the mind exerts upon 
the circulation of blood is immense. It is hardly 
necessary to tell theological students that " he that 
is slow to anger is better than the mighty, and 
he that ruleth his spirit is better than he that 
taketh a city." What I mean in quoting the pass- 
age of Scripture is to encourage you, as a matter 
of physical health, in your attempts to restrain 
your temper and preserve your equanimity at all 
times. You may think of a righteous tjzdignation, 
but beware how you indulge in it, for it is bad 
physically, bad for the heart. It is just as bad as 
going up stairs fast, a habit to which college stu- 



MAINTENANCE OF HEALTH, 1 5/ 

dents are generally addicted. I once asked an- 
other distinguished surgeon in New York, why it 
was that he, at so advanced a period of life, was 
so well. He said one of the reasons was that he 
never ran up stairs. We do not properly appre- 
ciate, I think, the strain which is brought to bear 
upon the circulation by rapidly ascending one or 
two or three flights of stairs. Just attempt to 
speak a few sentences consecutively after going up 
stairs rapidly, and then you can estimate some- 
what the effect the exertion has upon the respira- 
tory apparatus. 

There are some men who never get used to 
anything. They are always in a fret and fidget, 
and go through life in that condition. Such men 
are very much tried and annoyed by trivial cir- 
cumstances, and avail themselves of all manner of 
devices to avoid interruptions. I have heard that 
some ministers shut themselves up in their study, 
and bar the door to all visitors. This may be 
necessary at times, but many of you, perhaps most 
of you, will be in places where no such opportun- 
ity will be afforded you for getting away from 
interruptions. I am not sure that you should 
always bear with interruptions, but at all events 
you will be obliged to endure a great amount of 
them, and the sooner you get accustomed to 
them the better for your head, the better for 



15^ MAINTENANCE OE HEALTH. 

your circulation, in short the better for your 
physical health. You must learn to take them 
as a part of your life. If you fret over them 
and bluster about them, you will just add another 
pound to the burdens which you will be called 
upon to bear until you lay them down upon the 
last day of your lives. The christian virtue of 
patience successfully cultivated will contribute ma- 
terially to reaching a serene old age. 

Ministers in the olden time were very apt to 
encase themselves in broadcloth on all occasions. 
In my youthful days a Presbyterian clergyman 
always meant a man wearing a shiny black suit of 
clothes. In the pulpit and in the drawing room 
broadcloth is exactly appropriate and befitting, but, 
for the week day work of a country parish all 
that should be discarded. A cheap suit, yet of 
grave and dignified color, can now be obtained 
that will serve you much better than broadcloth, 
and in which you will feel free to take such 
exercise as will be of value to you. Fortunately 
we have ceased to follow the French in our 
clothing and are imitating the English ; hence 
comes the sensible costume worn by most people 
when they are not engaged in absolute professional 
duty. A kind of undress uniform of tweed cloth, 
will be found very useful and becoming. Such 
clothing will contribute to the desire for healthful 



MAINTENANCE OF HEALTH. 1 59 

exercise, by not showing every trace of use. Then 
in the summer, instead of sweltering in broad- 
cloth in the pulpit, alpaca may be worn. Attention 
to such details as these, insignificant as they may 
seem, actually contribute to the maintenance of 
health. 

Some people in America have adopted the 
French breakfast, and take only coffee and rolls 
in the morning. Most young men and men in 
middle life need, beside coffee and rolls, beefsteak 
or chop, potatoes, etc. In other words, I think 
the American breakfast is the typical breakfast for 
hard working men, and I hope that it will finally 
be adopted in our climate for people who get 
up early and work for their living. I find that 
when I spend my sumimers abroad, I get on 
very well with the fashionable light breakfast, 
because I do not work, but when I come home 
and resume labor, beginning regularly at nine A. M* 
I find that I need a real breakfast. Most of my 
associates say the same thing. So I think that 
upon the whole you may adopt the American 
custom of morning meal with a reasonable de- 
gree of assurance that it best meets the wants 
of a man who works hard either mentally or 
physically. I think, however, that the American 
hour for dinner as it obtains in country towns, is 
not a physiological one. As working men, sup- 



l6o MAINTENANCE OF HEALTH. 

posing your habit is to spend the morning hours in 
study and the afternoon in visiting, you will do 
better with luncheon at noon, taken without haste 
if possible, and while you dine as most people do 
in New York and other large cities, when the work 
of the day is done. I am assuming of course that 
you are not going to burn the midnight oil, but 
that the night is to be spent with your families 
and in the discharge of the lighter duties of your 
life. Your preparation for the Sabbath, and for 
the lecture which may accompany the prayer meet- 
ing should, I think, be made in hours illuminated 
by the sun. 

The management of the voice is an important 
matter with clergymen, and yet I fear that theo- 
retical advice in this regard is of little avail. 
Some men are so constituted that they manage 
their voices with great facility, while others have 
so much impetuosity in their nature that unless 
they are extremely careful they are sure to become 
exhausted by the immoderate use of the vocal 
organs. The proper management of the voice is 
a very great art. If you acquire that art you will 
save yourselves from disease affecting the back part 
of the pharynx, follicular pharyngitis as it is called 
in medical language, or ministers' sore throat in 
popular parlance. 

I do not know but the best advice I can give 



{ 



MAINTENANCE OF HEALTH. l6l 

you is to remember and keep the voice under 
the same control under which a wise man keeps 
his other muscular powers, for after all the larynx 
is an instrument controlled by voluntary muscles. 
You can play upon it with all the facility with 
which men learn to use a flute. 

The advertisements in the newspapers tell you 
a great deal about catarrh. There is no doubt 
that some gentlemen here believe that catarrh in- 
variably leads to consumption and very many 
worse things, for so we are often taught. 

If all that has been written and published con- 
cerning this affection were true very many more 
would be subjects of consumption than really are, 
because doubtless eighty-one-hundredths of all the 
people in our Northern climates suffer more or less 
from catarrh. The so-called catarrh is simply an 
increased secretion from mucous membrane. If you 
preach vigorously for an hour you will have a sub- 
acute attack of catarrh, and catarrh sometimes, 
though rarely, becomes a serious disease. It is 
however one of the torments of hfe which prevents 
us from being perfectly well ; a torment which has 
perhaps been given to us by inheritance, but 
sometimes is acquired by our own improper habits 
of Hfe, and want of good sound general health. 

Thorough frictions of the entire surface of 
the body after bathing are the fundamental 



1 62 



MAINTENANCE OF HEALTH. 



conditions of the prevention of frequent attacks 
of what is called catarrh or cold in the head. 

No address to students on hygienic matters 
would be complete without some remarks upon 
the care of the eye-sight. Three kinds of eyes 
need specially concern you. There is the short- 
sighted eye, of which there are several examples 
before me, that is, an eye which cannot see dis- 
tant objects distinctly without artificial aid. That 
aid consists of concave glasses. The gift of con- 
cave glasses to man was one of very great value. 

If Gustavus Adolphus had had concave glasses 
I think he would not only have won the battle 
of Lutzen, but also saved his own life, but, as he 
did not have them he was unable to distinguish 
his own colors, and became entangled among the 
Imperalists and was killed. Many a boy has not 
attained to his full development of character simply 
because he has not worn glasses. Such a boy 
goes out to play ball; he cannot see either the ball 
or the boy who throws it, and he is handicapped 
at once. All his views of life are very different 
from those which are obtained by people who have 
eyes with the proper focus. The eye balls in short- 
sighted eyes are too long from before backward, 
and in order that this anomaly may be corrected, 
concave glasses are put in front of them. 

If short-sightedness be not corrected in youth 



MAINTENANCE OF HEALTH. 1 63 

something is always lost, and perhaps enough to 
absolutely impair usefulness and limit a career, and 
yet it is sometimes very difficult to get short- 
sighted people to obtain glasses. The probable 
reason is that they do not compare their visual 
power with others, but only with their own actual 
eyesight. A man born with a short-sighted eye 
often does not know that he does not see so well 
as he should, until the fact is revealed to him by 
putting on a pair of glasses. One of the principal 
objections urged against wearing spectacles or eye- 
glasses by short-sighted persons, is that the visual 
power of the wearer is not so good immediately 
after taking them off. This is true, but it is 
because the eyes have been strained when the 
correcting glasses were not worn. The power of 
seeing more distinctly has been gained by the use 
of great muscular force. It is better to use glasses 
and save this expenditure, even if for a moment 
or two after removing them the power of seeing 
is not so good. 

This inability to see the sky and the stars, 
the hills, the mountains and the green fields, as 
other people see them, to recognize their friends, 
as other people recognize them, to see a ship upon 
the far out ocean, all these things must exert 
an influence upon the man's character. This has 
all been well said by special writers, such as Don- 



164 MAINTENANCE OF HEALTH. 

ders and Loring.* But it should be reiterated until 
this subject is properly understood. 

Hence I say correct your short-sightedness for 
distance. It is not necessary that short-sighted 
persons should use glasses for reading if the short- 
sightedness is only moderate in degree. If however 
it is great, so as to require a glass from four to 
six inches focal distance, you had better use a 
pair of glasses for reading also. The physiology of 
short-sightedness you will find in all text books 
upon physiology, and I will not enter upon its 
consideration. 

There is another kind of eye which you should 
know about and that is the eye of youth which 
require, the glasses of old age. This is what is 
technically called the hypermetropic eye. Anato- 
mically it is exactly the opposite to short-sighted 
eyes, that is, the eyeball is shorter than normal 
from before backwards. An old person needs 
convex glasses, because the eyeball becomes too 
short, from inability to lengthen it, as is required 
for seeing near and fine objects. The young eyes 
of which I am now speaking, are absolutely too 
short, and no muscular force can lengthen them 
sufficiently. It was a very great discovery that 
told us about these cases. It was made known by 
Bonders, of Utrecht, Holland, but Professor Dewey, 

* Transactions N. Y. State Medical Society — 1879. 



MAINTENANCE OF HEALTH. 1 65 

of Rochester, first discovered that glasses would 
correct this condition. Unfortunately, he published 
his paper in Silliman's Journal of Chemistry, a jour- 
nal read by chemists but rarely by doctors, so we 
lost the benefit of his discovery that this condition 
of things existed in young children, namely, that 
they had practically the eye of old age, and, hav- 
ing that condition, that it could be corrected by 
the use of convex glasses. Prof. Dewey published 
his paper in 1841, and Prof. Bonders announced 
the same discovery in 1851. 

The other kind of eye of which I wish to speak, 
is the overworked eye, the tired eye, what is 
called the asthenopic eye. It is well to remember 
that after all eyes are only eyes. 

There are certain things that cannot be done 
without danger of injuring the eyes. Among them 
is studying before breakfast, by the aid of dim 
light, especially if Greek, German, or Hebrew char- 
acters be those employed. 

Again, it is a bad habit to work for a number 
of hours uninterruptedly. The use of a bad light 
should be avoided. A gas light with or without 
an Argand burner is a poor light. The light 
furnished by a lamp in which some preparation 
of petroleum is burned, is much steadier and 
better than gaslight. The table should be so 
placed that the light will fall upon the work 



1 66 MAINTENANCE OF HEALTH. 

from the left side, so that it will not be interrupted 
by the arm if the man is right-handed. Illumina- 
tion from above is not good ; reading by twilight 
is bad for the eyes because the illumination is in- 
sufficient, and that means straining of the ciliary 
muscle in order to get exact vision. Strain con- 
tinued upon any muscle and not repaired by 
rest, is always dangerous and brings in its train 
a great many evil results. Then you must do 
the best you can about type. Whenever you can, 
choose good type, and make this one of the things 
that shall influence you in purchasing books to be 
used regularly. With regard to position, no man 
who is short-sighted should stoop while reading, 
but should build up his desk so that the book 
reaches the height at which the letters can be 
seen without bending the head and body. A 
desk at which a man may stand is very useful for 
short-sighted persons. Horace Greeley was a wise 
man in a great many ways, and I was always 
much interested in the manner he used to write 
in the Tribune office. Without the advice of 
Doctors, but by the aid of some of that divine 
fire which burned within him, he found out how 
a short-sighted person should read. His desk was 
so high that it brought his paper very near to 
his eyes, and placed him in a position in which 
he was not obliged to bend in order to see clearly. 



MAINTENANCE OF HEALTH. 1 67 

The bent position is very unfavorable to free 
circulation in the eyeball and brings dangers with 
it. I do not know but you will reach the conclu- 
sion soon that it is a dangerous thing to live, if 
all these precautions are so important. You may 
have heard of the country gentleman who when 
he heard that most people die in their beds, 
immediately said that he was going to give up 
the use of his bed altogether. But what I mean 
by these precautions is that by their observance, 
you will be able to avoid some dangers. All you 
cannot, for there come times in a man's career 
when he must expose himself to danger and 
fatigue that may ruin him for Hfe, but it is his 
duty and no other course is possible for him. 

But unnecessarily making one's self uncomfort- 
able and unnecessary sacrifices, are to be despised. 
I remember a colonel who distinguished himself in 
camp by doing unnecessary things, under the im- 
pression that it was enduring hardship like a good 
soldier. For example, he enjoyed sitting out in 
the rain and submitted himself to other needless 
exposure, imagining that it was soldier-like to be 
uncomfortable. You should take every precaution 
possible to preserve your health without becoming 
morbidly self conscious. 

If your eyes are merely tired and not diseased 
or of improper shape, they will soon recover them- 



1 68 MAINTENANCE OF HEALTH. 

selves by rest. You will always be able to deter- 
mine whether or not there is any serious affection 
of the optic nerve or retina by an examination to 
determine two points — First, whether you can read 
the finest type — Second, whether you can make 
out the letters corresponding to the heading of 
the New York Herald newspaper at twenty feet. 
Persons who habitually suffer from fatigue in using 
the eyes, although they may be able to see distant 
and near objects well, may still require glasses. 
They may be suffering from a concealed shortening 
of the eye ball, or want of focal power. Yet since 
the discoveries of Bonders there have been some 
exaggerated views as to the value of glasses in such 
cases. Glasses will not give any man or woman 
the power to abuse their eyes. You have as yet 
nothing to do with the eyesight of old age, but 
the years are rolling on and you will soon reach 
that time. Remember when that time comes that 
glasses will be of great service to you. You need 
not look upon them as an instrument that will weak- 
en or destroy your eyesight, but rather as one of 
the greatest boons given to mankind. Some of the 
most absurd arguments have been made in the pres- 
ent day about using glasses, arguments such as that 
the untutored savage never has any need of glasses, 
and that hence we need none. No doubt the un- 
tutored savage does not need glasses, neither does 



MAINTENANCE OF HEALTH. 1 69 

the savage need Greek, but if he should read and 
follow the light and the labor of civilization and 
christian enlightenment, he would require them. 

An anecdote is related of Rufus Choate in this 
wise. Mr. Choate, after he was forty years of age, 
was pleading a case before one of the great Massa- 
chusetts judges, and on referring to his notes he 
was seen holding the paper further and further off 
in his endeavor to decipher his manuscript, until 
at last the judge annoyed him prodigiously by 
saying, "■ Mr. Choate, I would advise you to get 
one of two things, either a pair of tongs or a 
pair of spectacles." 

Gn account of the limited time at your disposal 
and mine for these lectures, much of what I have 
had to say, has been of necessity given in an ab- 
rupt and fragmentary manner. I hope, however, 
that I have suggested something that will serve as 
a guide to the care of your health. As a parting 
word I would say, attempt to fix in your mind 
rather the principles than the rules for the care of 
your bodies. The rules will be deduced as the 
occasion requires, if the fundamental principles be 
correct. 



THE RELATIONS OF THE MEDICAL PRO- 
FESSION TO THE STATE. 



VII. 

THE RELATIONS OF THE MEDICAL PRO- 
FESSION TO THE STATE. 

The country in which we Hve is still a new 
one. Many of our forests are primitive and much 
of our soil is uncultivated. Even in our oldest 
States we may see regions upon which man, by 
his residence and labor, seems hardly to have 
made a sensible effect. We have scarcely any of 
the garden-like cultivation of England, we have 
no wood -parks like Ardennes and Fontaine- 
bleau, no gray towers on our river banks, and 
few of the broad and hard highways over which 
Moltke's armies marched to Sedan and Paris. 
In our vast country there is a constantly recurring 
impression of newness, and, in a certain sense, of 
roughness. I am not unmindful of what we 
have achieved in the way of invention, manufac- 
ture, commerce, and culture. I merely wish to 
recall to your minds a fact that we are all per- 
haps inclined to forget, namely, that we are still 

* The Address of the President of the Medical Society of the 
State of New York, in 1879. 



174 MEDICAL PROFESSION AND THE STATE. 

a new people in a new land. We cannot inherit 
the fullness of cultivation of the older peoples in 
our intellectual work any more than in the culti- 
vation of our soil. Our relations as individuals or 
as guilds and professions, to each other and to the 
government, must of necessity be different from 
those which obtain among older nations with their 
centuries of history and of tradition. In Europe 
there has been time for many things to arrange 
themselves into a refined system. The profession 
of medicine in a country like England, or France, 
or Germany is sensibly influenced by these condi- 
tions of age and fixity, and is in certain established 
relations to the State, which make unnecessary 
many of the discussions into which we are con- 
stantly drifting. The ordinary aud extraordinary 
necessities of our government, have left Httle time 
for such minor matters as the determination of 
the relations to it of a class which the State has 
practically declared to have no formal connection 
with the governing powers. The process of arrange- 
ment is, however, now going on. For the next 
hundred years the people of the United States will 
devote much time, not only to the refinement of 
their material condition, to their highways and 
hedges, their fields and lawns ; but also to the 
relations of the various guilds into which the 
people are divided, to the State to which all give 



MEDICAL PROFESSION AND THE STATE. 1/5 

allegiance. May I then beg your attention to a 
consideration in outline of the relations of the 
medical profession to the State ? I have said, de- 
liberately, that we must be engaged for the next 
hundred years in establishing and perfecting them, 
for I have no idea that in our generation we shall 
do much more than begin a work which can only be 
completed in many decades of time. No dream of 
a homogeneous, vast, organized and cathoHc body, 
untormented by schism or disorder, in settled rela- 
tions to the civic authorities, has passed over my 
mind. I do not anticipate that the legislation of 
this or of any subsequent session of our ancient and 
honorable body will create a medical Utopia, but I 
hope that each one of its meetings will accomplish 
something toward the establishment of the medical 
profession in such proper relations to the State as 
shall redound to our advantage and honor, as well 
as to that of the commonwealth. 

I am not one of these who beheve that we 
must model all our affairs after those of the Old 
World, that what is right for England, Germany and 
France must of necessity be right for the United 
States ; but I hold that there must be many things 
in which we shall improve upon the ways of the 
older nations, and that, from the very nature of 
things, there must be many ways in which our 
modes differ from theirs. 



i;^ MEDICAL PROFESSION AND THE STATE. 

I will consider the relations of the medical 
profession to the State under several heads. 

I. — As Witnesses to Aid in the Detection of Crime ^ or 
the Breaking up of Nuisances. 

It is probable that the singular contradictions 
of some of our medical experts have excited 
the wonder of laymen and a sense of shame in 
medical men. The laity have sometimes asked 
if there are really no fixed rules for the deter- 
mination of the existence of metallic poisons in 
the human body ; if there is no evidence of in- 
sanity that may be clearly shown to a jury ; if 
there is no standard as to what is a perfect 
cure of a fracture ; and if it be not possible for 
the physicians of New York to agree as to whether 
the noise from an elevated railway is an injury 
to the nervous system. We know, and all intel- 
ligent laymen know, that there must always be dif- 
ferent shades of opinion upon the same subject, in a 
science so unsettled and progressive as our own ; but 
nobody yet knows why it is that experts can always 
be found who honestly believe that no antimony ever 
was in a certain stomach, when it has been already 
discovered by supposed reliable authority, or why 
one man is pronounced to be raving mad by 
Professor A., and competent to take charge of vast 



MEDICAL PROFESSION- AND THE STATE. IJJ 

estates by Professor B. Neither does any man 
know why Dr. X. beheves that all broken limbs 
ought to heal without shortening, while a profes- 
sional brother, of equal position, positively states 
that no legs ever unite without some lessening in 
length. Neither do any of us probably under- 
stand why a large number of physicians are in- 
duced to say, that *' perverted mental and moral 
action, cerebral exhaustion, insomnia, hysteria, cho- 
rea, mania, paralysis, meningitis, and decay of 
nutrition," will be largely promoted by life along 
an elevated railway, while other authorities state 
that *' medical literature," according to their belief, 
" does not afford a single instance of any of 
these diseases being caused by noises such as 
are produced by the cars on an elevated railway. 
The system in our law that allows able and zeal- 
ous law^xrs to coach and pay their own experts 
until they have made honest partisans of them, is 
certainly vicious. The State should summon, the 
State should pay experts, and they should act 
as associate judges, to aid the real judges in getting 
the truth before the jury. The plaintiff and 
defendant should undoubtedly have the right of 
putting their case before the medical experts, and 
exercise a choice in selecting them ; but the 
medical man should receive his honorarium from 
the State, and never be put in the position, as an 



178 MEDICAL PROFESSION AND THE STATE. 

expert, of being a witness for one side. Then 
the physician, surgeon, or chemist would go upon 
the stand, so far as it is possible for human leg- 
islation to attain such an end, without fear and 
without the idea of favor. Napoleon asked Du Bois 
to treat the Empress of France in labor, as 
if she were a peasant woman in a hospital, 
instead of a sovereign in a palace. The medical 
man should be placed in a position where he 
may be able to treat a medico-legal case as he 
would a dead body under his scalpel. 

The subject of the adequate payment of 
medical experts comes, of course under this head. 
As matters now stand, physicians may be obliged 
to make long journeys, and give, for a mere 
pittance valuable opinions, the fruit of years of 
toilsome observation. It is the opinion of many, 
which is shared by your speaker, that the whole 
subject of payment of those who work for the 
government should be carefully looked over, and 
that such an examination will show that a great 
and powerful State ought to pay its servants 
so well, that the best men may be claimed and se- 
cured for its service. Certainly experts should not 
be taken away from their ordinary duties without 
a compensation that will, at least to some con- 
siderable extent, recompense them. This society 
has already taken action upon the subject of pay- 



MEDICAL PROFESSION AND THE STATE. 1 79 

ment for expert testimony, by appointing a com- 
mittee to ask the Legislature to consider this subject. 

II. — As Defendants in Suits for Malpractice. 

It is a matter of mortification that there 
should be any necessity for such a relation of 
the profession of medicine to the State as this. 
But physicians are unfortunately not exempt from 
the frailties and faults of humanity, and they 
must expect to answer at the bar of justice for 
any crimes they may commit. In what I have 
to say, there is no claim for any immunity from 
punishment for neglect of duty or culpable ignor- 
ance on the part of a medical practitioner ; but 
I shall simply attempt to show how, under our 
present system of inquiry, medical men are at 
the mercy of ignorant jurors and unscrupulous 
lawyers. It is often the case, that after medical 
men have given their time without fee or reward, 
they are called to account on a charge of mal- 
practice that has no other foundation than that the 
patient did not recover in the manner in which 
he or his friends thought he ought to have done. 
I frankly admit, however, in the outset, that we 
ourselves are in a measure to blame for the tone 
of expression about the work of physicians, which 
is somewhat prevalent among the people. 



l80 MEDICAL PROFESSION AND THE STATE. 

It has often pained many of us, I am sure, 
to hear a medical practitioner boast, even in the 
presence of laymen, of cures that he has made, 
when another man, his peer, had blundered. This 
idea of considering the result as largely due to 
personal and extraordinary gifts, is the basis of 
the notion among the laity that the attending 
physician is to blame if an eye be lost, a frac- 
tured limb be shortened, or if a patient die 

from disease. ** If Dr. had not done so and 

so," or *'if he had done so and so," in the 
common phrase, the patient would not have died ; 
or, as I have often heard it much more strongly 

put, " I have always thought that Dr. killed 

that person." This is no fancy sketch. It is as 
flippantly and commonly asserted in ordinary social 
circles, that physicians often kill patients by neglect 
or stupidity, as that plumbers put in defective 
material and leave holes in waste-pipes. In a 
famous play of Moliere's, one of his characters con- 
stantly jeers at the faculty in such phrase as 
this : " All the excellence of their art consists in 
pompous nonsense and idle babbling, which give 
words for reasons and promises for performance." 
— toute Vexcellence de leur art consiste en un 
pompeux galimatias^ eh un specieux babil qui vous 
donne des 7nots pour des raisons et des promesses 
pour des effets. No criticisms are more uproar- 



MEDICAL PROFESSION AND THE STATE. l8l 

iously received from a stage, than such as these, 
even in France where our calling has always 
been held in high esteem. Moliere well expresses 
the tendency of society, and in our own time 
some of its most cutting sarcasms are directed 
upon the ignorance and want of skill of medical 
men. The speaker knows of a social discussion 
of the merits of a celebrated oculist, which was 
ended by the serious assertion of a man not at 
all unfriendly to the subject of remark, in the 
following way : '' Well, he has put out a great 
lot of eyes." To lightly accuse a man of being 
a liar — or a thief is still considered a disgrace 
in any society in our land ; but a doctor is im- 
puted with malpractice in as free and easy a 
manner as the most trifling peccadillo is charged 
upon a servant. But we, as a profession, should 
first clear ourselves from any complicity in this 
kind of detraction, before we turn upon those 
who lightly bandy charges against medical men. 
If each of us would ever guard his brother's 
honor as his own, and promptly avow a disbelief 
in the charge of malpractice which is so frequently 
brought to him by a patient who is about to 
change his physician, the flippant tone often 
observed in society in regard to the services of 
medical men would soon be changed to one of 
respect. Skill of hand, years of experience in 



l82 MEDICAL PROFESSION AND THE STATE. 

the observation of medical cases, are sometimes 
temptations to lead men to suppose that they 
can turn away the hand of disease and death 
when others have failed ; but a Httle sober thought 
of our own impotence when the inevitable time 
has come, will soon lead us to an aversion to 
any special claims for healing power. Let us feel 
the sad truth, that there is a destiny that shapes 
the issues of life and death, rough hew them 
as we may, and no pressure of need for daily 
bread, no desire for success and fame — above all, 
no wish to triumph over another physician, will ever 
cause us to put ourselves in the attitude of trades- 
men praising our wares, or of skilful mechanics 
promising to repair or build. Our position should 
be rather that of experienced, careful, and cool- 
headed mariners, well provided with compass, 
chart and lead, who hope by the blessing of God 
to bring the good ship into port, but who do 
not claim to control the fog and the storm, 
which, in spite of the most careful navigation, 
are sometimes the destruction of a gallant ship 
and crew. 

There is need for a remedy for some of the 
worst features of these suits for malpractice. One 
of the states of our country, which is always in 
the van in any progressive political or social move- 
ment, has already passed a law which does away 



MEDICAL PROFESSION AND THE STATE. 1 83 

with the system of coroners' juries as it now 
obtains in New York. By this new law of IMass- 
achusetts, the office of coroner is abolished. In 
his stead is a medical examiner, and not until 
his investigation as to the causes of death is ended 
is there any calling upon the civil power which, 
then appears, if necessary, in the form of the 
district attorney and a justice. In our State the 
coroner may not be even a physician, and he may 
be a very ignorant man, while the coroner's jury is 
usually obtained in the easiest way possible. When 
we remember that serious medical questions are 
very often involved in the decisions of such a 
coroner and such a jury — questions affecting the 
reputation and freedom, perhaps even the life of a 
physician — we do not wonder that one State has at 
last done away with the bad system to which New 
York still clings. Let me give one instance from 
many that could be cited of the workings of a cor- 
oner's jury in our State. A physician in New York 
city was recently summoned as a witness in the case 
of a man who had died from acute meningitis 
resulting from an inflammation of the middle part 
of the ear. The relatives of the deceased had 
avowedly set the investigation on foot, because 
they beheved that the physician who was called 
as a witness, had caused the death of the man 
by a surgical operation which he had performed 



1 84 MEDICAL PROFESSION AND THE STATE. 

upon the drum membrane. The friends and the 
jury were of a low type of unlettered day-laborers. 
The coroner had never received a scrap of medical 
education, and very little of any other. The 
theory of the investigators was that the instru- 
ment used to open the abscess in the ear, had 
entered the brain and caused a fatal bleeding. 
It was shown that the man walked away from 
the place where the operation was performed 
much relieved of severe pain, and that he returned 
two days after, expressing himself as much bene- 
fited. Three days after this he died, not having 
seen the surgeon after his second visit. The jury 
examined and cross-examined the physician who 
had performed the operation as to his skill and 
character, and several witnesses of the same intel- 
ligence with the jury testified very freely as to 
their opinion of the cause of death. The an- 
imus of the jury was so marked that the coroner 
was obliged to resort to some urgent advice to 
prevent them from bringing in a verdict which 
would have compelled the surgeon to appear 
before a grand jury. Although there was not 
one shadow of evidence of malpractice, but rather 
of proper and kindly treatment in a hospital, where 
as usual all the services of the attending surgeons 
are absolutely without fee, the jury finally brought 
in the following remarkable verdict : '' We the jury 



MEDICAL PROFESSION AND THE STATE. 1S5 

come to the conclusion that came to his death 

by a rupture of the blood-vessel or small brain, 
or with some instrument used by doctors unknown 
to the jury." Medical men, suspected or accused 
of negligence or want of skill, should be protected 
from the wrong of an examination of their case 
bv those who have none of the knowledg^e ne- 
cessary for the conduct of such an inquiry. The 
profession has long since asked for protection from 
another fault in our system, which allows a certain 
class of lawyers to take up cases of alleged mal- 
practice on speculation, as it is called. Both in 
this country and in England physicians are quite 
often put to great expense and loss of time, in 
defending themselves from frivolous charges, which 
usually fall to the ground even when brought 
before a jury of men utterly unacquainted with 
the science of medicine. The law can probably 
give us but little relief from these attacks, for 
the full right of appeal to a court for redress 
should never be unduly restricted. But the law 
can see that, if tried we must be, it shall be by 
"careful judgment of our peers" — a right that 
should never be denied to ene of Anglo-Saxon 
blood. 

More than this, we can come to such a cor- 
rection of sentiment in our own profession, that 
it will be impossible to find medical instigators 



1 86 MEDICAL PROFESSION AND THE STATE. 

of unjust suits. Most of these frivolous cases, 
unfortunately for our fair fanae, depend upon the 
willingness of some medical men to lightly assert 
that a case has been improperly treated, and 
that in their skilful hands the result would have 
been different. One of our remedies for unjust 
attacks upon the faithfulness and skill of medical 
men must be found in such an elevated tone of 
professional sentiment as will prevent us from 
imitating the vilest of birds, that are said to 
foul their own nests. 

III. — As Educators of the Physicians of the Future 

Although, from the very early history of this 
country, the community has taken an active in- 
terest in education, and even in special education — 
that of ministers, lawyers, and teachers, scarcely 
anything has been done for the instruction of 
medical students except by the individual effort 
of men who elected themselves to be professors 
in the medical colleges which they founded. In 
the State of New York, at an early date, there 
was an attempt at a medical college which should 
be a department of King's, now Columbia College. 
In this the European idea of responsibility of 
the faculty to a Senattis Academicus was a fea- 
ture ; but this state of things did not continue^ 



MEDICAL PROFESSION AND THE STATE. 1 8/ 

and to-day not one of the leading medical colleges 
of the State is anything more than a first-class 
educational estabhshment, owned and practically 
controlled in all its details of financial manage- 
ment and appointment of professors, by a body 
usually of seven men. They are at the same 
time proprietors and teachers, just as much as 
*' John Jones, A. M." is the proprietor of and pro- 
fessor in "the famous and large boarding-school 
situated on the banks of the Hudson, in full 
view of the Catskill Mountain House and the 
haunts of Rip Van Winkle.'' As a matter of 
course, the announcements and circulars of these 
colleges betray their private character, and offer 
the most flattering inducements to their patrons, 
while their buildings are surmounted by flagstaffs 
from which float their emblazoned banners. The 
contrast between the announcements of medical 
colleges in this country and the catalogues of 
the Universities of Vienna, Berlin, and Strasburg^ 
with their sober, unpretentious detail of the names 
of teachers and the facilities open to the aspirant 
for medical knowledge, is not at all creditable 
to our sense of propriety and good taste. All 
that the State has to do with these colleges is 
to prescribe that students in them shall study 
three years, that they shall be twenty-one years 
of age when they graduate, at which time they 



1 88 MEDICAL PROFESSION AND THE STATE. 

shall also be possessed of a good moral character. 
From the beginning to the end of the course of 
study, the men who teach in our medical schools 
are absolutely masters of the situation, and the 
ultimate judges as to the qualifications of those 
whom they send forth. The State virtually says, 
and the community still more positively : While 
we have an interest in the quality of our lawyers, 
and we see to it that the various religious bodies 
look after the character of their ministers, and we 
educate teachers at the public cost, we leave the 
whole business of making medical men to the 
private institutions where they are instructed. It 
is true that in some of these colleges there is 
a titular connection with so-called universities, 
but he who makes the acquaintance of the manag- 
ing boards of these institutions soon finds that 
they have an actual contempt for the idea that 
it is any part of the duty of a board of coun- 
cillors or regents to look after the characters or 
acquirements of the men whose diplomas they 
are signing. They are not at all unwilling, how- 
ever, to publish the list of medical students in 
long columns, and upon the credit of it take to 
themselves the name of university. But to these 
directors medical education is entirely a private 
affair. So far from encouraging a close union 
between the departments really united to the 



MEDICAL PROFESSION AND THE STATE. 1 89 

governing board of the college or university, they 
have been known in some cases to actually tax 
the medical department for the honor of being 
connected to such a stepmother. It is greatly to 
the credit of the medical colleges of this State 
that they have maintained medical teaching at a 
high standard, in spite of such a system and 
such an indifference and hostiHty as have been 
delineated. Whatever may be said to the con- 
trary, any exact examination will show that the 
medical teachers of the State have always been 
foremost in the efforts to extend sound know- 
ledge. Actual count will show that their books 
furnish the most by far of those published on 
medicine, and that their papers greatly outnumber 
those presented at the meetings of medical societies 
by their fellow-members of the profession. Apt 
as is the medical press to decry medical professors, 
it may be safely asserted, that the temptations 
of their irresponsible position have not overcome 
them, but they are among the chief promoters 
of scientific culture. Something better than a 
desire to advertise themselves and to secure a 
pecuniary reward, has usually animated the men 
who have founded and maintained our colleges. 
Admitting all this, there are so many evils in the 
present system, as it obtains in all but one of 
the medical colleges of this State, that a change is 



1 90 MEDICAL PROFESSION AND THE STATE. 

imperatively demanded. We need an examination 
for admission, a graded and fuller course, and a 
more rigorous final examination. The only prob- 
lem to be solved is, how shall we secure these 
ends ? I think, if we turn our eyes again to the 
State of Massachusetts, we shall find there the 
only certain means of reforming our medical colleges. 
But I hold that the State cannot undertake the work. 
In a country where there are sects, and danger- 
ous sects in medicine, where men who are ignorant 
of anatomy and physiology are rated as physicians, 
the work of an examining board appointed by politi- 
cal authority, that owes allegiance to the people — to 
whom all so-called doctors, whether sons of seventh 
sons, bone-setters, patent medicine makers, or grad- 
uates of colleges and hospitals, are alike — would 
be a farce. Whatever may be proper for Eng- 
land and Germany, the United States are not yet 
ready for an alliance of medicine with the State. 
Neither do I believe that this society or any 
other society can successfully undertake the su- 
pervision of the medical colleges.* The older mem- 
bers of this society can tell us of the failures of 
the system of censors, and we know how the 
last law in regard to examinations by county socie- 
ties has succeeded simply in legalizing every kind 
of a nominal physician. But observe what has been 

* As will be seen by those Y/ho read a subsequent paper in this 
volume I have changed my opinions upon this point. 



MEDICAL PROFESSION AND THE STATE. IQI 

done by the President of Harvard University. 
With great ability and far-sightedness he has brought 
its medical school into close and responsible re- 
lations to his Board of Trustees as a part of his 
scheme of raising a college to the dignity of a 
university. He has taken it out from its inde- 
pendent position and made it, like academic, law, 
scientific, dental, and theological departments, a 
part of a whole. That once done, professors once 
independent of the favor of students, the exist- 
ence of the school no longer dependent upon num* 
bers, all needed reform became possible. Harvard 
has led where we must sooner or later follow. 
The University of Pennsylvania has also taken a 
step, although not a very long one, in the same 
direction, and the medical college at Syracuse as 
well as the medical department of Union Uni- 
versity adopt the Harvard plan. The sentence 
against the voluntary and irresponsible system has 
been pronounced by the higher sense of the medi- 
cal profession. There is some delay in carrying it 
into effect, but of the final result there can be no 
doubt. 

This intimate connection of medical colleges 
with boards of trustees is only to be secured by 
a recognition of the true status of medical depart- 
ments of universities and by endowment. The 
State, as such, however much we may ask of its 



192 MEDICAL PROFESSION AND THE STATE. 

individual members, should not be expected to as- 
sist, even much less to endow, medical colleges. 
Neither special education nor special charity should 
be the function of a free, as contradistinguished from 
a paternal government. We have not passed through 
one hundred years of independent life to at last 
be bound in the swaddling-clothes of infancy. 
Besides, if there were no other good reason against 
governmental endowment, it would not be safe 
for our catholic profession to seek and secure an 
alliance with the State until the average legislator 
knows the difference between the man who is a 
physician and the man who calls himself one. The 
profession itself should secure these endowments. 
We should begin to use our powers with wealthy 
and influential laymen, and secure for the cause of 
sound medical education its share of public regard. 
It is our own fault that even intelligent men know 
nothing of the subject, and consequently have no 
interest in it. A prominent man in one of our 
cities, himself one of the governing board of a 
college with a medical department attached, whose 
diplomas he was in the habit of signing, once told 
a teacher in that department that he supposed 
medical students graduated after one year's study ; 
and another member of a governing board of a 
university in this country, once said that he had 
yet to learn that medical education formed any 



MEDICAL PROFESSION AND THE STATE. 1 93 

part of university training. If educated laymen do 
not know that a real university should have a med- 
ical school as a part of it, and that they have a 
vital interest in the quality of doctors sent out to 
practise among them and their families, we must 
teach them all this. Then they will endow our 
schools, and give them the facilities, and cause them 
to make the advances demanded by our time. Here 
is the kernel of this whole matter of reform in 
medical education. Anatomical, chemical and phy- 
siological chairs, and laboratories in colleges, and 
clinics in hospitals, should be properly although 
not extravagantly endowed, so that medical schools 
may be maintained even without excessively large 
classes. The present necessary laxity in admissions, 
and in final examination, fairly overwhelms the 
land with physicians. Many of them are only so 
by title. What was adequate in requirement for 
1779 is not sufficient for a hundred years later. 
Our good medical colleges have all resorted to 
makeshifts in reform, but all the new demands are 
voluntary and not obligatory, so that if a man 
chooses he may graduate in our State with large 
acquirements ; but if he does not so choose, or if he 
is not able to do so, he may get a diploma with 
very moderate attainments. I am not one of those, 
however, who believe that a proper system will of 
itself turn out good medical men, or that any 



194 MEDICAL PROFESSION AND THE STATE. 

amount of education will compensate for want of 
brains. A man may be graduated from a college 
here and study abroad, and yet be utterly incom- 
petent to practice medicine ; while a college ed- 
ucation and foreign travel are of inestimable value 
to nearly all who are fortunate enough to get them 
and wise enough to appreciate their advantages. 
When John Hunter, who could barely read and 
write at twenty years of age, heard that he was 
reproached by a rival with being ignorant of the 
dead languages, he replied : " I would endeavor 
to teach him on the dead body, that which he 
never knew in any language, living or dead." 

Our colleges must be made better then, by 
being considered as one of the objects of phil- 
anthropic aid, as well as art galleries, observa- 
tories, schools of science and of theology. I 
doubt if one hundred thousand dollars has ever 
been contributed in this State toward the cause 
of medical education. But how shall this overtaxed 
and heavily burdened community find the means 
for this new call upon its benevolence ? By 
sparing from its useless expenditures that which 
is here so much needed. 

In the little churchyard at Stoke-Pogis, marked 
only by his name, lie the remains of the immor- 
tal man who wrote — 



MEDICAL PROFESSION AND THE STATE. 1 95 

" Can storied ujii or animated bust 

Back to its mansion call the fleeting breath ; 
Can honor's voice provoke the silent dust, 

Or flatt'ry soothe the dull, cold ear of death ? " 

In Spite of these words, which should have 
an influence wherever our tongue is known, our 
beautiful cemeteries, where may ever grow the 
rose, the violet, and the forget-me-not, continue 
to be disfigured by costly sarcophagi and monu- 
ments and to be associated with funereal pomp. 
The money thus used could well be given where 
it might aid to lengthen life or mitigate disease. 

The State has yet much to do in the matter 
of legalizing the dissection of unclaimed dead 
bodies. This is a difficult matter to manage. 
The chief trouble lies in the natural repugnance 
of the human race to the mutilation of the 
body after the spirit has left it. We bury our 
dead with a tenderness and care that show how 
we reverence the temple in which the soul was 
enshrined. The humblest and the poorest share 
this sentiment with the noblest and most affluent. 
Yet, without the dissection of dead bodies, with- 
out the careful rehearsal of surgical operations, 
anatomical knowledge and skill in surgical work — 
knowledge and skill necessary to save life, are im- 
possible. The suggestions of some wild sentimen- 
talists in our own profession, and of tender-hearted 



ig6 MEDICAL PROFESSION AND THE STATE. 

journalists, that we shall get our knowledge and skill 
from models is simply puerile. Who would know- 
ingly trust his life or limbs to a surgeon who had 
never traced out the nerves, muscles, and blood-ves- 
sels on the dead body, but who had only studied 
anatomy on wax models ? The public was deeply 
stirred last winter by the desecration of the graves 
of honored pubHc citizens in a distant State. In- 
dignation waxed hot because some of the under- 
Hngs of a medical college had robbed the abode of 
the dead. None of us have aught to say in exten- 
uation of the misdemeanor of those who violated 
the sanctities of the grave. Yet we may urge the 
State of Ohio, and all other States, to facilitate 
the necessary study of anatomy and surgery among 
students and practitioners by allowing medical col- 
leges to freely use all the unclaimed dead bodies, of 
which there are, unfortunately, many on this sad 
earth. Let us, as a profession, never for a moment 
permit the notion to become popular, that we can 
attempt to teach or to practise without a know- 
ledge of the human frame derived from actual 
study of its structure in the dissecting-room and 
on the post-mortem table. 



MEDICAL PROFESSION AND THE STATE. 1 9/ 

IV. — As Managers of Institutions for the Care of 
the Sick and Injured. 

There is a widely diffused belief among busi- 
ness men and lawyers, that physicians and clergy- 
men have very little of the ordinary tact neces- 
sary for the financial care of large interests. It is 
undoubtedly true that men thoroughly devoted to 
the high matters of the care of morals and health 
cannot at the same time give much attention to 
strictly business affairs. But in any economical 
plans involved in the care of the souls and bodies 
of their two charges, the two professions show 
an astuteness, and manage their affairs with a 
success, that may safely invite comparison. A 
devotion to religion or science is not at all in- 
compatible with correct business ideas as to the 
erection and maintenance of a church or hospi- 
tal. 

Some of the great minds of the world have 
been famous for the ability with which they 
carried out the details of their calling. Samuel 
Smiles says that it was because the Duke of 
Wellington was a first-rate business man, that he 
never lost a battle. People are beginning to get 
over the notion, if they ever entertained it se- 
riously, that true genius despises the wisdom of 



IQo MEDICAL PROFESSION AND THE STATE. 

this world. A man is none the less a cool sur- 
geon, a wise physician, because he attends to his 
own financial affairs and those of his hospital 
with care. There is really nothing in the idea 
that a physician may not be as good a manager 
of economical and financial interests as a lawyer 
or a banker. Not because he is a good physician, 
but because to be a good physician he must 
first be a capable man. The history of an average 
business career in this country is not so flattering 
that the class which represent it can afford to 
claim an exclusive knowledge of how to manage 
hospitals and asylums. The record of the manage- 
ment of the army hospitals during the civil war, 
by physicians and surgeons of the army of the 
country, is a complete answer to those who would 
put away medical men from the care of their 
own. Distrust of the business and executive ca- 
pacity of medical men, mingled with a notion that 
they are contentious, are the real reasons for the 
almost universal exclusion of medical men from 
the governing boards of hospitals and dispensa- 
ries. Yet this distrust is not founded on facts. 
Physicians may have been unfit managers of affairs 
when they were men of the cloister and the 
library, when they spent their time in reading 
the theories and fancies of other men, or when 
they devoted weary nights to the crucible and 



MEDICAL PROFESSION AND THE STATE. 1 99 

the discovery of the elixir of life. But we have 
changed all this. The long gown of the study 
and the gold-headed cane of the consulting-room 
have been put aside for the dress and equipment 
of an active life. Medical learning now depends 
upon close study of the human frame itself, and 
not of ponderous folios — upon practical experi- 
ments in the laboratories and exact observation 
in the sick-room by the aid of all kinds of 
physical instruments, and not upon the develop- 
ment of fancy-woven theories that had no basis 
except in the disordered minds of their inventors. 
The well educated and well trained physician of 
to-day may manage a hospital with a facility 
quite equal to that of a man learned in dry 
goods, politics, or the stock board. It is evident 
that the genius of our time has not only changed 
the character of the medical profession ; but also 
enlarged its sphere to a remarkable degree. We 
are being educated up to the responsibilities which 
the demands of the age have thrust upon us. 
Neither the community nor physicians have yet 
come to a full appreciation of these facts. Hence, 
the old condition of things obtains. Hospitals 
are built without medical or sanitary advice, by 
gentlemen who have acquired their notions of 
hygiene by years of study of day-books, ledgers, 
and real estate investments, interspersed with a 



200 MEDICAL PROFESSION AND THE STATE, 

grand tour of Europe, during which they have 
visited the badly planned hospitals of Paris ; and 
they are officered by philanthropists who think 
the only safe way for those who value sound 
financial management, as well as peace and quiet- 
ness, is to keep the doctors out of boards of 
direction. Some of the hospitals erected by lay- 
men, in the full light of what was shown by 
the hospitals built by the profession during the 
late war, are very far from being models of eco- 
nomical and healthy structure. The cost of taking 
care of patients in some of the grand buildings 
of England and America is equal to that of board 
at our first-class hotels, with the services of a nurse 
and a consulting and attending physician included 
in the bill. Put ph3^sicians in fair proportion on 
the boards of erection and management of hospit- 
als, and we would soon change all this, and in- 
augurate in civil hospitals the system that has 
given to the medical officers of the United States 
Army a wide and enduring fame. 

V. — As Protectors of the Community from. 
Quackery. 

In the discussion of this part of our theme, 
there is at the outset a difficulty in definition. 
There is no difficulty with us who are of the 



MEDICAL PROFESSION AND THE STATE. 201 

profession, but in the minds of those who are 
not in our calHng. An average man, even a col- 
lege-bred man, is very apt to consider medicine as 
an experimental art, with not much, if any, science 
about it ; for operative surgery he may have 
some respect ; but medicine is so largely a matter 
of guess-work, that to many such men the opin- 
ion of a person who has no exact knowledge of 
the human frame is as valuable as that of the 
most learned and experienced practitioner. When 
such a man is seriously ill he waits eagerly for 
his physician, and professes great estimation of 
his aid. When merely ailing, however, he does 
not hesitate to prescribe for himself, or to accept 
the prescriptions of any person whom he may 
chance upon, and who is willing to tender him 
advice. He will also visit Saratoga or Richfield, 
and enter upon a course of treatment by means 
of the waters there, without dreaming that it 
might be well to take the advice of a physician 
before resorting to such active medicines as are 
contained in Congress or sulphur springs. I think 
it is Mark Twain who tells the story of a sea- 
captain who had a chest of medicines, with a 
book, and various remedies numbered according 
to directions in the book. On the occasion of 
the illness of one of his sailors, the captain found, on 
consulting his manual, that No. 14 was the med- 



202 MEDICAL PROFESSION AND THE STATE. 

icine required. No. 14 happened to be out, but 
on reflection he concluded that a combination that 
would make those numbers would do as well. 
He accordingly prescribed 10 and 4, and was 
very much surprised that a burial at sea was 
the result of his scientific experiment. Very few 
people venture to give opinions in regard to 
purely mechanical employments, unless they are 
trained to them ; but the whole community, ed- 
ucated and ignorant aHke, are quite willing to 
prescribe for disease and to explain physiological 
phenomena. At not very long intervals our news- 
papers give us highly colored sketches of the 
woman who has been unable to leave her bed for 
years, who cannot use her hands naturally, and 
yet does wonderful things with them ; who sees 
with her eyes closed better than those of us who 
have ours open, who lives without eating and who 
is altogether a supernatural being. Sympathizing 
friends gather around the poor hysterical and epi- 
leptic sufferer, the victim of disease of the nerves 
and of excessive sympathy, and as they go away 
proclaim the modern miracle. The press and the 
clergy vie with each other in their sensational ac- 
counts, and in some instances they are aided and 
abetted in this work by members of our own pro- 
fession. If such cases as these come to be re- 
garded as real exceptions to the laws governing 



MEDICAL PROFESSION AND THE STATE. 203 

disease and the functions of the body, we may as 
well put the dial marking medical progress back 
to the dark ages, and assimilate our views of God's 
government of the world to those of Cotton Mather 
and his fellow witch-executioners. These things 
show how far we are from a rational view of the 
science of medicine, and the cognate subjects. 
They also show how much remains for us to do 
in creating and maintaining a healthy public sen- 
timent. A connivance with wonder-mongers, and 
miracle-workers greatly delays the day when our 
science and art shall receive the full respect of 
the laity. I have no time to adequately discuss 
the subject as to whether there is or is not a 
science of medicine. That there is, we know ; that 
there is a science both in the administration of 
drugs, and still more perhaps in refraining from 
giving them, we are all sure ; but how are we 
to expect a community that for centuries has 
had thrust upon it, without protection from the 
State, races of bone-setters aud clairvoyants, and, 
still worse, of men and women without even a ru- 
dimentary knowledge of the structure and functions 
of the human body — a community whose ears have 
been deafened by the din of the sects as they 
have vaunted their systems of cure — how can we 
expect them to define a charlatan or quack, when 
they still believe that a knowledge of the prac- 



204 MEDICAL PROFESSION AND THE STATE. 

tice of medicine is a divine gift, that may, like 
the poetical genius, be developed in the brain 
of an illiterate plowman, or be the heritage of a 
seventh son of a seventh son ? 

While we may not ask the State to endow 
medical schools, we may certainly expect that it 
will protect its citizens from well-defined quackery. 
It certainly cannot discriminate in regard to modes 
of treatment, when there must always be such 
honest difference of opinion. The State cannot 
catalogue the drugs that may be used, or name 
the doses ; but it is the bounden duty of a Gov- 
ernment that cares for the welfare of its inhabitants, 
to see to it that no one is allowed to prescribe for 
diseases who has not furnished evidence of a satis- 
factory knowledge of anatomy, physiology, and 
chemistry. It should also interfere to prevent the 
sale of so-called patent medicines, and of adultera- 
ted medicines and food. A State that will not do 
this should, in all consistency, allow mad dogs to 
run in the streets, lunatics to go at large, and 
gunpowder to be stored in every house, and leave 
its railroad crossings without guards or signals. 
There would be no abridgement of the rights of 
the citizen in such a protection. If a man does 
not know enough to guard himself from the ad- 
vice of those who prescribe for a machine of 
which they do not know the mechanism, the 



MEDICAL PROFESSION AND THE STATE. 205 

State should interfere to protect him, just as it 
provides the commonest means for public safety, 
by means of the poHce and the army. 

What is wanted is a board of examiners, made 
up of the best men from the colleges and the 
profession, who shall determine, not the ortho- 
doxy of a candidate as to the doses of drugs or 
the uses of cold water and vegetable medicines, 
but as to whether he has been well grounded 
in the structure and functions of the human body, 
the remedies for poisons, the rules for action in 
emergencies, and the principles of diagnosis, a 
knowledge of which will at least, protect his pa- 
tients from scandalous malpractice. If, however, 
civil service reform has not reached a point that 
assures us that the board can be appointed solely 
on the ground of professional fitness, and without 
the taint of partisan politics upon it, we are better 
off as we are now, with no guards whatever except 
those that we set up among our own members. 

VI. — As Sanitary Advisers to the Commonwealth. 

This is perhaps the most comprehensive and 
important of any of our relations to the State. 
It is the one now receiving general attention, and 
there is a prospect of its proper adjustment. There 
are, however, still many obstacles on the part of 
the powers that be, in the way of yielding to 



206 MEDICAL PROFESSION AND THE STATE. 

physicians as a class, even in matters purely san- 
itary. We here meet the same difficulties that 
we have already discussed under other heads. 

Physicians are still very largely regarded as 
fit only for the necessary but narrow walk of 
their caUing — in prescribing for disease that has 
already broken out, and for taking charge of ac- 
cidents that have already occurred. Preventive 
medicine, which you and I are most anxious 
about, is not yet fully appreciated by our law- 
makers. A physician is often considered as a 
kind of fire-extinguisher, to be sent for in case 
of a conflagration, but as rather a useless member 
of the body politic when there is no actual crisis. 
We are not singular in being thus unappreciated. 
Lawyers are the most valuable and most occupied 
in the prevention of litigation, soldiers are chiefly 
useful to avert war ; and yet advocates and soldiers 
are very often regarded as of no use except in the 
court-room and on the battle-field. To think in 
this way is to wholly misunderstand the work of 
the professions. There is a kind of exultation in 
the remark that a physician has not made a pro- 
fessional visit to the household during the year. 
So far as immunity from actual disease goes, 
this delight is as proper as it is natural, but 
many a man and woman who smile at the idea 
of the need of medical advice, are walking surely 



MEDICAL PROFESSION AND THE STATE. 20; 

towards the edge of a precipice from which sound 
counsel might keep them. 

The physician should have the same prerogative 
in the State as in the family, and no man can be 
properly said to be a conscientious physician who 
does not, if allowed, have a general, vigilant, but not 
impertinent oversight of the hygienic arrangements 
of the household of which he is the sanitary in- 
spector and adviser. There should be a board of 
health in every county and in every town, and 
this board should have no man upon it who 
has not a medical, scientific or legal education. 
Not a school-house, not a jail, not a hospital, not 
a sewer, should be built unless competent sani- 
tary advice, with power to enforce it, be given. 
There are many other things of which physicians 
should have the oversight, which are now entirely 
neglected. As instances of these may be men- 
tioned the supervision of the hygienic condition of 
prisons, public charities, private and public insane 
asylums. A supervision that is connected with the 
ordinary management of these places is not suffi- 
cient, however careful and conscientious may be 
the officers. Experience has shown that routine 
habits may be acquired, which only vigilant gov- 
ernmental supervision will prevent. 

The attention of the medical profession has 
been lately called, both in Europe and our own 



208 MEDICAL PROFESSION AND THE STA TE. 

country, to the great proportion of people who 
have no proper idea of the difference of colors. 
Examination has shown that this proportion exists 
among railway and steamship officials. When we 
cross the ocean and sail up the English channel 
with its thousand of craft, as we are in our cabin 
unconscious of danger, the man on the lookout 
may not be able to tell a red light from a green 
one, or we may have been journeying on the rail- 
way to this capital behind an engineer who is 
equally incompetent for his important duty. We 
should follow the example of Sweden, and demand 
such a searching investigation as will put in other 
positions men whose visual defects now render 
them useless and dangerous in places where col- 
ored signals are used. In the future no steam- 
ship or railway should be allowed to employ a look- 
out man, switchman, or an engineer who cannot 
satisfactorily submit to the tests for the percep- 
tion of colors. 

Here is room for reform. Here is work for 
the closing years of the nineteenth century. What 
a change in public sentiment is to be made 
to bring about a proper state of things ! And 
yet how necessary ! In one of the most beau- 
tiful hill regions of this country, or of the world 
— in a spot where the sunrise and sunset are 
such as must shine upon the Delectable Moun- 



MEDICAL PROFESSION AND THE STATE. 209 

tains — a place where the mists that roll away be- 
fore the sunlight disclose green forest-covered moun- 
tain-tops that are the glory of the land — in a 
spot where the water leaps clear as crystal in 
cascade and waterfall, or meanders along the val- 
ley in the placid brook, man had so long neglected 
the necessary hygienic arrangements that the foulest 
and deadliest materials at one time contaminated 
the water and the air, and with this brought 
disease and death. The hotels were closed, their 
visitors scattered — some of them dying, however, 
before the source of evil was detected. Nor is 
this a solitary instance ; it is only a specimen of 
what is constantly occurring. Epidemic upon epi- 
demic has visited communities, notably in the 
South, fever has constantly broken out in beautiful 
valleys, children have become the victims of spinal 
distortion, sight has been impaired and lost by 
the thousand of cases, and all for the want of 
scientific and medical care. 

What may be done in preventive medicine is 
perhaps nowhere better shown than in the ex- 
emption of our city of New York from cholera 
and yellow fever. ' A wise system of quarantine, 
rigorously carried out by an intelligent and incor- 
ruptible physician with great executive ability, 
while it has not restricted the freedom of commerce, 
has averted epidemics from a large population. 



210 MEDICAL PROFESSION AND THE STATE, 

Some time since, three representative physicians 
called upon the mayor of a large city to ask him 
to appoint a doctor upon a board having charge 
of the public schools. Among the score or more 
of lawyers, politicians, and business men, who oc- 
cupied the chairs, there was not one medical 
man. Several political reasons were given for de- 
clining this modest request, but the chief one, of 
a general character, was that physicians could hardly 
be found who could give the time from their 
occupations to this preventive work. Assuming 
that this was an honest reason, it shows a marvel- 
lous ignorance of the functions of medical men, 
and a supreme want of appreciation of the fact 
that should be evident to thinking people, that the 
physicians of our time have as one of their chiefest 
functions that care of the community which shall 
prevent deformity, disease, and death. 

The recent epidemics of yellow fever at the 
South are startling appeals to the State and to 
the medical profession. Can nothing be done to 
prevent this awful waste of human life? Must 
this grief of a desolated population continue to 
arise ? The experts in sanitary science have told 
us that thousands of the deaths at Memphis, Gren- 
ada, and New Orleans were in consequence of mu- 
nicipal violation and neglect of well known sanitary 
laws. Somebody has blundered. From what we 



MEDICAL PROFESSION AND THE STATE. 211 

know in our own State of the powerlessness of 
medical authorities in such matters as the cleansing 
of sewers and streets, it is to be feared — indeed, 
it is known, that Tennessee, Mississippi, and Louis- 
iana, like New York, are not at all awake to the 
necessity for medical supervision of the house- 
keeping of all towns and villages. The principle 
that, in order to promote public health, the town, 
the village, and the cit}' must be as rigorously 
cleansed as the body of an individual, must be 
taught by us, until the people everywhere under- 
stand that the care of the public health is one of 
the highest duties of the officials of the State. 

How can we hasten the day? It is a mistake 
of the poets that a good cause must certainly pre- 
vail. Many an honest and wise effort for the ad- 
vancement of the human race has been strangled 
in the hour of its birth. Many a persecution has 
successfully stamped out a growing crop that prom- 
ised a blessing to its time, and has left only 
blood and desolation in the mark of an iron heel. 
However good a cause, it needs advocates and 
an impartial judge. It is true that the eternal 
years of God belong to truth, but it is also true 
that error and sin are often triumphant for a 
time that is interminable to its victims. 

" No ; things will never right themselves. 
' Tis we must put them right." 



212 MEDICAL PROFESSION AND THE STATE, 

Two things must earnestly be seen to by us, 
if we will hasten the day when the medical profes- 
sion shall assume its true relations to the State. 
They are unity of action and a jealous regard for 
our reputation as a profession. 

In one of the conflicts of opinion in the med- 
ical profession that so often occur in all large bodies, 
an astute and experienced layman of New York 
remarked to a medical man who wished to secure 
his aid on one of the sides which had been formed 
in the profession : " If the gentlemen of your pro- 
fession could simply agree with each other, you 
could rule the city." It is certainly true that, if on 
the sanitary and medico-legal questions of the day 
we were united, we could accomplish in a few years 
that which, with our present modes of action, 
will require decades. When Benjamin Franklin 
was endeavoring to arouse the Colonies to resis- 
tance to the exactions of Great Britain, he cir- 
culated among the doubting and divided patriots 
an emblem of a serpent cut into thirteen parts, 
and accompanying it the motto, " Join, or die." 
Whether we are dissevered or united, we shall 
still exist as a profession. So long as man is 
subject to accident and disease we shall form an 
integral part of the commonwealth, but the prom- 
inence and proportions of that part will depend 
upon our individual integrity, our wise delibera- 



MEDICAL PROFESSION AND THE STATE. 213 

tions, when assembled in council, and our unity in 
action when our deliberations have closed. We are 
an isolated class as we labor in the tenement-house 
and the hamlet, the hospital and the palace, al- 
ways with the suffering and the dying, harassed 
and worn by our self-imposed weight of human care, 
and our voice may seem only as one crying in 
the wilderness, as we lift it for reform ; but as 
we gather to-night, the honored and experienced 
head of age side by side with the enthusiastic 
smile of youth, the dullest can see, that while we 
are without pomp, banner, or emblem, we may 
yet be a power in the State. 

If we desire to be an influential body in the 
affairs of the State, we must always be jealous for 
the honor of our craft. The achievements of in- 
dividuals must become the property of the whole 
profession. They should be as tenderly and safely 
guarded by us as are the battle-stained and bullet- 
torn flags of regiments that have been through the 
valley of death. No personal considerations should 
ever induce us to decry the fame of men whose 
accomplishments have given American medicine 
an honored name all over the world. If there 
be nakedness to cover, let us step backward fil- 
ially, with our faces turned, while we throw our gar- 
ments over it. With united front, let us who 
struggle for the prolongation of life and the mit- 



214 MEDICAL PROFESSION AND THE STATE, 

igation of disease, continue our advance in the 
same column with those who, by cultivating the 
soil, by humane and wise legislation, and the 
administration of law, by the finding out of many 
inventions, by the inculcation of the principles of 
morahty and religion, contend for a land and a 
time when " the wilderness and the solitary place 
shall be glad for them, and the desert shall re- 
joice and blossom as the rose," and the Eternal God 
shall wipe all tears from the faces of men. 



VIII. 

HOW SHOULD OUR HOSPITALS BE 
GOVERNED ? 



VIII. 

HOW SHOULD OUR HOSPITALS BE GOV- 
ERNED? 

All the people in the city of London, and 
perhaps many in England, who take an interest 
in the care of the sick poor, have been lately very 
much disturbed by a serious agitation in the man- 
agement of one of the best hospitals of the British 
metropolis. This disturbance — for the trouble has 
been, and is serious enough to be called by that 
name-^occurred in Guy's Hospital. This hospital is 
by no means the oldest in London. St. Bartholo- 
mew's in Smithfield, and St. Thomas's on the Thames, 
over Westminster Bridge, ranking it in that regard. 
But it is one of the most celebrated and best in 
London. It was founded by Thomas Guy, a book- 
seller, in 1723. He is said to have made the for- 
tune which enabled him to endow this great char- 
ity, by the rather incongruous occupations of selling 
bibles and engaging in the South Sea Bubble Spec- 
ulation. The medical school in connection with 



2 1 8 HOW SHO ULD UR HOSPITALS BE GO VERNED ? 

Guy's Hospital has been served by such men as Sir 
Astley Cooper and Dr. Bright. It is perhaps the 
leading medical school in London. In this hospital, 
such a serious disagreement has occurred between 
the managers or governors, who are laymen, and 
the medical staff, that it is believed that the en- 
tire question of the proper management of the 
charity, will be brought before Parliament at its 
next session. 

Those who have read what has been said in 
some of the preceding pages of this book, in re- 
gard to hospital management, will know that such 
outbreaks are no surprise to the present writer. 
Indeed, they are what is to be expected under 
the present system. A few years ago a very se- 
rious disagreement, from causes similar to those 
which have produced the trouble at Guy's, occurred 
in the Presbyterian Hospital of this city. The 
outcome of this trouble was the resignation of 
the majority of those of the medical staff who 
had not already been dismissed. After this, per- 
haps the largest assemblage of physicians that ever 
came together in the city of New York, in a 
carefully prepared set of resolutions, applauded the 
action of the medical staff, and denounced that of 
the governors. 

There was but one physician on the board of 
management, and yet in consequence of this trouble 



HO W SHO ULD UR HO SPI TALS BE GO VERNED ? 2 1 9 

with the doctors, several of the most influential of 
these resigned also. The misunderstandings, em- 
barrassments, and ill feeling engendered by this dis- 
pute are slowly disappearing, but it may be truth- 
fully said that the whole matter has seriously 
embarrassed the managers of the hospital in their 
care of the trust assigned to them by the gener- 
osity of the late Mr. James Lenox. Besides this out- 
break it is a matter of common fame, that in the 
oldest hospital in our city, there has been a kind of 
latent misunderstanding between the Board of Gov- 
ernors and the Physicians, which, while it has never 
attained to the dignity of a quarrel, has led to 
bickerings and strong language unworthy of either 
of the honored bodies that have indulged in the 
underhanded war on the other. If it were necessary 
many other instances quite as marked could be 
cited, that show the amenities of the present sys- 
tem of hospital government as it obtains in the 
United States and in England, 

Before I go any farther in illustrating the diffi- 
culties in the present system of the government of 
hospitals, it may be well to describe just what that 
system is. In New York city, and I believe in 
most if not all of the cities of this country, the 
hospitals, with the exception of a few small ones, 
are governed by a board made up of merchants, 
bankers, lawyers, and the like. Rarely or ever is a 



220 HGW SHOULD OUR HOSPITALS BE GOVERNED? 

person who has received a medical education upon 
these boards. A member of the medical staff is 
never a governor. This board appoints a superin- 
tendent or matron, or both, and committees from 
the board visit the hospital with more or less 
regularity. In our country these duties, although 
done without pay. are usually as faithfully per- 
formed as if there were a salary attached to the 
office of governor or manager. No complaints are 
ever current that those gentlemen have neglected 
to keep a thorough oversight of the hospitals under 
their charge. In this respect we seem to be much 
better off than are the people of Great Britain. 

Hospitals seem to be governed in London on 
the same general plan, that is, there is a board 
of lay managers who have the nominal and abso- 
lute control of the affairs of the hospital. But 
practically their work does not seem, if Guy's 
Hospital be a fair example, to have been done 
as faithfully as it is in New York. 

Although Guy's Hospital is nominally managed 
by governors, only one governor, the treasurer, has 
very much to do with the control of its affairs. 
All the other governors leaving almost all matters 
to him, he is supreme. He has power to appoint 
and to dismiss matrons and direct nurses — in fact, 
to be a kind of dictator. So important is the 
office of treasurer in London that that official in 



HOW SHOULD OUR HOSPITALS BE GOVERNED? 221 

St. Thomas's Hospital* ''built a new hospital at a 
cost of ^600,000, utterly refused to listen to the 
advice of those who knew about hospitals, and 
thus crippled for an indefinite number of years a 
charity in which now about one-half of the beds 
are occupied, and in which the governors are try- 
ing to tide over their difficulties temporarily by the 
reception of paying patients." At Guy's Hospital, 
according to the writer I have just quoted, " the 
recent financial administration has been so deplor- 
able, that, notwithstanding the great wealth of the 
foundation, it has been necessary to close beds for 
want of funds, and yet the treasurer at this very 
conjuncture is said to have found it possible and 
to have thought it proper to expend ^3000 upon 
the improvement of his official residence." 

It will be seen that there is no corresponding 
position in the government of any New York 
hospital to that of treasurer of a London hospital. 
The use of an official residence for the philanthro- 
pist who takes sufficient time to see to the ac- 
counts of a hospital, would be considered as in 
the highest degree absurd. As a matter of fact 
the governors of New York hospitals generally at- 
tend to their duties, and do not at the worst del- 
egate them to less than half a dozen of their col- 
leagues. In some of them they do not delegate 

* Correspondent of London Times, July 27, 18S0. 



222 HGW SHOULD OUR HOSPITALS BE GOVERNED? 

any of their duties at ail, and no work is better 
done than that done by these managers. 

But we are children in these matters as com- 
pared with the citizens of London ; when we get to 
be older the flagrant abuses of a bad system will 
occur. Just such perversions of a great trust, just 
such neglect of official duties, as have occurred and 
have been permitted at St. Thomas's and Guy's will 
be found in the management of our hospitals also. 
The trouble at Guy's seems to have been pre- 
cipitated by a lady. Miss Lonsdale, who wrote an 
article for the Nineteenth Century, entitled *' The 
Present Crisis at Guy's Hospital." Miss Lonsdale 
is an accomplished Christian gentlewoman of Eng- 
land, who has taken up the overseeing of nursing 
as one of the occupations of her life. She spent 
some six weeks at Guy's Hospital in practical 
work, after a change in the matron and nurses had 
been made, and came to the conclusion that the 
previous system of nursing had been very bad. 
Her views, or similar ones, had influenced the treas- 
urer to such a degree that he had removed the 
matron, and she in her turn nearly all of the old 
nurses. All this seems to have been done, as such 
things are constantly done in hospitals, without any 
consultation with the medical staff". They were sud- 
denly confronted with a new regime, with its new 
regulations, without so much as a courteous state- 



HOW SHOULD OUR HOSPITALS BE GOVERNED? 22 ^ 

ment that these changes were about to be made. 
The reader can imagine the consternation caused 
to the medical men of a large hospital, when they 
suddenly find strange faces at all the bedsides, and 
where rules which allow the head-nurse to be habit- 
ually absent when the doctor makes his visit, are 
put in force. The trouble and disagreements became 
very marked and numerous. In the midst of them 
Miss Lonsdale pubHshed her first paper in the maga- 
zine which has just been mentioned, and since then 
the war between the laity and the profession has 
gone on only to be interrupted by the summer holi- 
days. It will be renewed when the " season " be- 
gins in London. 

I will quote some passages from Miss Lonsdale's 
paper. They will give an idea of the spirit of the 
attack upon the doctors, and as I believe an idea 
of the nature of misunderstandings that are in- 
evitable v/hen the rightful authorities, the medical 
men, have no power to carry out their plans, and 
when the plans of people less qualified are en- 
forced in spite of their protests. 

" Until comparatively lately our hospitals have 
been nursed by women drawn mainly from the 
class to which the domestic charwoman belongs, 
who, having received no kind of training whatever, 
were perhaps first taken into the hospital after a 
superficial inquiry, or no inquiry at all, has been 



224 1^0 W SHOULD OUR HOSPITALS BE GOVERNED? 

made into their character, in the position of scrub- 
ber or ward-maid, in order that they might see 
and learn, as well as they could, what went on 
there 

" Physically and morally untrained as they were, 
they were then immediately liable to be put in 
charge of patients who were more or less seriously 
ill, by day or by night as the case might be ; the 
main duty which was inculcated on them from their 
first acquaintance with hospital work being that they 
must study the character and special requirements 
and fancies of the particular medical man or sur- 
geon under whom they were placed, with a view of 
gaining his approbation by every means in their 
power 

" She [the nurse] came back . at the regulation 
hour, more or less the worse for drink as the case 
might be, and went to bed to sleep off the effects 
of it ; no inquiry was made into her condition, 
since it was nobody's business, as long as she 
satisfied the medical men by the work which came 
under their notice, to ask how her hours off duty 
were spent, or what her own moral condition might 
be 

" I do say that, as a rule, their [the nurses] 
moral character was unsatisfactory." 

After Miss Lonsdale has compared trained nurses 
with those characters which she has described with 



HO IV SHOULD OUR HOSPITALS BE GOVERNED? 22 5 

such a free hand, she wonders ''why certain mem- 
bers of the medical profession, who are on the 
acting staff in hospitals where there is a large 
medical school, should oppose with remarkable per- 
tinacity the employment in their hospitals of the 
intelligent class of trained women who are sup- 
porting the new system. They carry their opposi- 
tion so far as to affirm that under the old system, 
if the nurses were drunk and dissolute, it was of 
no consequence, so long as, as far as they could 
see, the patients did not suffer. This saving clause, 
*as far as they could see,' is perhaps one clue to 
the strange pertinacity of the doctors 

" A doctor is no more necessarily a judge of 
the details of nursing than a nurse is acquainted 
with the properti,es and effects of the administra- 
tion of certain drugs 

" I ask, are not practices and experiments in- 
dulged in by the medical men, and permitted by 
them to the members of medical schools, which it 
is understood had better not be mentioned beyond 
the walls of the hospital 

"Under the old system, doctors and students 
alike were at no trouble to consider either their 
own manners or the feelings of the nurses, and 
there was Httle occasion. They became accustomed, 
therefore, to behave in wards exactly as their nat- 
ural disposition prompted them 



226 HOW SHOULD OUR HOSPITALS BE GOVERNED? 

*' Yet this unconscious restraint might in time 
prove powerful to smooth down the roughness of 
medical students, who are, as a rule, universally 
acknowledged to be uncouth." 

It is no wonder that an article containing such 
sentences as those which have been quoted, should 
have caused a great stir in the medical world. 
It will be seen that it is plainly charged that the 
doctors had either shut their eyes to or connived 
at incompetency and, worse still, at immoral prac- 
tices, going on with the nurses, medical students, 
and, finally, with the doctors themselves. It is 
taken for granted that medical students are un- 
couth ; but the statement of all most liable to 
criticism, although not the most offensive, is the 
one in which doctors are said to know nothing 
of nursing. A perfect storm of indignation was 
excited, and many answers were given to these 
statements by eminent medical men connected with 
the hospital. It was clearly shown, as anyone 
will see who will take the trouble to read the an- 
swers in the Nineteenth Century, that Miss Lons- 
dale had been incorrect, and inconsiderate at least, 
in many of her statements. Sir William Gull says 
of her article, " The tone in which she has writ- 
ten of all concerned, whether medical men, stu- 
dents, or nurses, is exaggerated, disrespectful and 
unfair." 



HOW SHOULD OUR HOSPITALS BE GOVERNED? 22/ 

In another article Miss Lonsdale took occasion 
to modify what she had stated so broadly, and 
says, " Nothing is so much to be deprecated as any 
breach between the doctor and the nurse, whose 
hearty co-operation is essential to the comfort, 
nay, it may be to the recovery itself, of the pa- 
tient. Any concession that will insure this happy 
result of concord, short of the conception of right- 
ful authority on the part of the doctor over nurse 
and patient, should cheerfully be made." 

Worse than all this wordy discussion, a case 
of maltreatment of one of the patients, which 
was decided to be one of manslaughter, occurred 
in the wards of Guy's Hospital after the new sys- 
tem of nursing, so arbitrarily instituted by the 
treasurer, had been established. The m^anslaughter 
was committed by one of the nurses of the new 
regime, for which she is now suffering the punish- 
ment meted out to her by the judge. 

Carrying out the principles initiated by Miss 
Lonsdale, thinking that doctors know no more of 
nursing than nurses do of drugs, this nurse dragged 
a feeble patient, without orders, to a bath, from the 
effects of which she died. Certainly there is a crisis 
in Guy's Hospital. At this moment the matron and 
the medical staff have no communication with each 
other. The treasurer states, in answer to the house 
physicians, that he "did not care for the opinion of 



228 HOW SHOULD OUR HOSPITALS BE GOVERNED? 

eight frivolous young men." * One of the lesser 
evils of the present system of the government of 
hospitals exclusively by gentlemen who have no 
medical education is shown in this answer of the 
treasurer to the house doctor. These *' frivolous 
young men " are graduates of a medical school, are 
generally enthusiasts in the study of medicine, and 
often highly educated. They are often contempt- 
uously treated by the lay authorities of a hospital, 
while as a rule they are on the best of terms 
with their superiors on the medical staff. Naturally 
enough they do not consider a trained nurse, no 
matter how blue her blood, or a treasurer, no 
matter how great his financial skill, as their supe- 
rior in matters involving a knowledge of medicine 
and hygiene. Frequent collisions and a good deal 
of bad temper will be seen, if boards of governors 
and managers continue to be made up of men 
who think that young doctors are necessarily ig- 
norant and frivolous young men. Let their su- 
periors be men whom they willingly admit to be 
possessed of much more knowledge and experience 
in the medical management of a hospital than 
themselves, and they will be found as tractable 
and serious as can be desired. In regard to the 
matter which precipitated the trouble between the 
treasurer and the doctors at Guy's, there ought to 
* Letter of House Physician, Times, August ii, 1880. 



no IV SHOULD OUR HOSPITALS BE GOVERNED? 22g 

be no misunderstanding in the minds of the public 
at large as to the position of medical men. 

Despite all the statements of such enthusiasts 
as Miss Lonsdale, physicians have always been 
anxious to secure the very best nursing. But it 
may be frankly stated at the outset, if a crisis 
is to be forced upon us in New York also, that 
doctors will never submit to any system of nurs- 
ing which assumes to take any responsibility on 
the part of the nurse that ordinarily belongs to the 
physician. We might as well understand that every 
good physician believes that he knows more about 
nursing than does any nurse ; no matter at what 
school she was graduated, no matter to what family 
she belongs, no matter what doctors coached her 
in her calling. Not to know about nursing, as has 
been stated over and over again in the discussion 
in London, is not to know about the practice of 
medicine. To give up the control of the patient 
to the nurse is to give up the control of the 
treatment of the case. No man who has any re- 
spect for himself or his calling will ever submit 
to either. It has been foreseen by thoughtful 
men in the profession that a new system of nursing 
would bring with it some new dangers. Whether 
a little learning is dangerous or not is a question 
not yet fully answered ; but that a little learning 
in the possession of persons of certain temperaments 



230 HOW SHOULD OUR HOSPITALS BE GOVERNED? 

is very dangerous, if they are entrusted with power, 
will generally be conceded. Trained nurses, as they 
now obtain in New York, are very warmly wel- 
comed by the profession as a new aid in their 
work; and unless they assume authority such as 
the disciples of Miss Lonsdale at one time at- 
tempted to assume in London, they will meet 
with the same cordial, thankful treatment in the 
future as they have received in the past. 

This question whether nurses are responsible 
to the matron and the treasurer or to the doc- 
tors, is only one of the many subjects for dis- 
agreement that will exist so long as the medical 
staff are not fully represented on the boards of 
management. The casus belli in the hospital in 
New York, which I have mentioned, was the dis- 
missal of several of the visiting staff by the govern- 
ors. Yet these men were not actually dismissed. 
The governors simply refused to re-appoint some 
of them, without assigning any special reasons for 
their refusal. Such appointments are usually sup- 
posed to be during good behavior and compe- 
tency. A dismissal in this manner, without a hear- 
ing, in the language of the chairman of the 
mass meeting of physicians, was considered as an 
" affront," and as such it was resented. A doc- 
tor's position as an attendant to the sick in a 
hospital, should be the same as his position with 



HOW SHOULD OUR HOSPITALS BE GOVERNED? 23 1 

relation to his patients in a private house. And 
yet how different are his relations in these two 
conditions. When a physician is called to a patient 
in a private house, he has absolute control. The 
servant who opens the door for him, and the nurses 
who assist him, pay him the most complete defer- 
ence, not only in manner but in deed. If he 
should order every window in the house to be 
opened every ten minutes in the course of the 
day, that order would be carried out, or the physi- 
cian would be dismissed and another one called. 
But so long as he is in attendance he is absolute 
master of the situation. 

Now, why is all this reversed when the number 
of patients is multiplied by hundreds, and the 
scene of their illness is transferred fromi the luxu- 
rious chamber of the rich to the wards of a hos- 
pital ? Why is it that, all at once, doctors are 
supposed to be unable to make the orders upon a 
large scale which they had been making upon a 
small one? It is simply because the profession in 
the beginning abrogated the powers which rightfully 
belong to them. Probably at first it was for the 
sake of convenience ; and probably it was- not fore- 
seen that the day would come when, unless they 
asserted their full rights in the management of the 
sick, the most serious consequences would follow. 
The only remedy for this state of things is to at 



232 HOW SHOULD OUR HOSPITALS BE GOVERNED? 

once reform the management of every hospital 
which now has none of its medical staff upon the 
board. 

The difficulties between medical boards and 
boards of management are now so frequent, that 
they are matters of common talk in many institu- 
tions. Speaking metaphorically, such bodies are 
often in the attitude of hostile cats glaring at each 
other, with malice in their eyes. In all the other 
relations of life, the men who compose these two 
bodies get on very well. It is not a matter of 
the men who make up these boards. These feuds 
depend upon the bad system which prevents doc- 
tors from having a fair share in the government 
of hospitals that could not live a day without their 
services. From what is known of the sessions of 
the boards of governors, one of the questions often 
discussed by them, roughly stated, is, " How shall 
we get on with our cranky doctors ? " They will 
never get on properly with them until the medical 
staff is fairly represented in the control of the 
hospitals which they serve. 

This unfortunate state of things is primarily 
due to the neglect of physicians to claim their 
rights. 

It is perpetuated because hospital positions are 
so important to scientific medical men. They are 
afraid to agitate the question on which they feel 



HOW SHOULD OUR HOSPITALS BE GOVERNED'/ 233 

SO deeply, lest they may lose the places which 
they would much prefer to retain, even embarrassed 
as they often are in holding them. As yet plenty 
of medical men, not always, however, of the high- 
est ranks, can be obtained to fill the places of any 
who resign because the carrying out of their proper 
functions is interfered with. 

How should a hospital be governed ? We have 
not far to seek for an answer. St. George's Hos- 
pital in London is governed upon what the present 
writer believes to be proper principles. " The board 
of governors is composed of gentlemen of all pro- 
fessions, the members of the medical board being 
equally eligible with others for the position. Each 
governor must subscribe as much as five guineas 
a year to the institution, and they meet as a 
* weekly board ' every Wednesday. To this meet- 
ing every governor is entitled to come, and when 
there he is entitled to speak and vote upon any 
question which is brought forward. The medical 
officers of the hospital are governors like others, 
by virtue of their subscriptions, not ex-officio^ and 
they also can speak or vote as they please. This 
system does not work confusion. The board-meet_ 
ing, as a rule, is composed of a small number of 
governors, who attend regularly and are conversant 
with the routine business, so that they represent 
all the usefulness of a committee, and the doctors, 



234 1^0 W SHOULD OUR HOSPITALS BE GOVERNED? 

or some of them, are nearly always present, and 
thus, if any suggestion of which they disapprove 
is brought forward, they are able at the very be- 
ginning to explain the light in which it appears 
to them. If any sweeping change were to be at- 
tempted, governors who seldom attend would come, 
for the special occasion, to support or to oppose 
it. The result of all this is, that although the 
medical staff are a small minority among the gov- 
ernors as a body, they have opportunities of being 
heard which are denied to them elsewhere, and 
they bring their special experience of hospital re- 
quirements to bear upon the beginning of every 
important discussion." * 

This is the way in which a hospital should be 
managed. There are small hospitals in New York 
and Brooklyn in which, practically, the same sys- 
tem of medical added to lay governorship is carried 
out. I appeal to the thinking pubHc and to the 
medical profession itself, to reflect and act upon 
this subject. By speedy reform in this matter, 
our New York hospitals may avoid such a con- 
flict as in one instance has already occurred here, 
and such serious disaster as now threatens Guy's 
Hospital in London. 

* Correspondent of London Times^ July 27, 1880. 



MEDICAL NEW YORK— OLD AND NEW 



IX. 

MEDICAL NEW YORK— OLD AND NEW. 

An Address Delivered at the Inauguration of the New 
York Post-Graduate Medical School. 

The recollection of the oldest inhabitant of Paris or 
London does not run back to the time when each of 
these cities was not a great metropolis. The tradi- 
tions of these great centres are those that belong to 
vast populations. From time immemorial they have 
contained crowded streets, long lines of shops, grand 
cathedrals and the other attributes of great towns. 
New York may well claim to be a metropolis ; her 
vast commerce and her million and more of people 
are sufficient to justify her claim. She is certainly 
a mother city now. But she is a modern metropolis. 
Her traditions are those of a provincial town, vying 
with Boston and Philadelphia and Newport for the 
honor of being a chief city in a frontier country. There 
are probably New Yorkers in this assemblage who re- 
member the time when the pigs ran about Broadway, 
and when every family that kept a carriage was known 
by name and by sight by the average citizen. 

The rapid growth of New York offers an explana- 



238 MEDICAL NEW YORK— OLD AND NEW. 

tion if not an apology, for many of the imperfections 
that exist in the management of her public affairs. We 
can hardly expect of an overgrown and awkward boy 
the culture and understanding of a man. It is difH- 
cult for one who has seen with his own eyes the won- 
drous change that has converted New York into one 
of the centres of the world, to realize that the things 
and methods that were suitable for a small town will 
no longer fulfill the requirements of a great city. The 
changes that are so marked in the commercial and 
social life of New York are none the less decided in 
the position of that profession which, through some of 
its representatives, has solicited and secured your 
presence to-night. 

New York as a town containing a few doctors, one 
small medical college, with a hundred medical students, 
offers a great contrast to the medical metropolis that 
we live in to-day. If the consideration of such a theme 
before this audience needs any apology, it may be found 
in the fact that much of the good health of the city 
and the nation may depend upon the character and 
wisdom of a resident profession that annually sends out 
five hundred or more new doctors to practice with 
drugs and cutting instruments. 

At one time, a little before 1841, the one medical 
college of New York was so little known or was so 
obscurely situated that an aspiring student, now a dis- 
tinguished professor, could not be directed to it by the 



MEDICAL NEW YORK— OLD AND NEW. 239 

gentleman to whose office he went to begin his medi- 
cal studies. Yet this was the day of Mott, of Kearney 
Rogers, of Griscom the elder, and of Alexander H. 
Stevens, of Hosack and of Francis. The New York 
Hospital was upon Broadway, in front of Pearl Street, 
its grounds covered by green grass and studded with 
ancient trees. This hospital and not the college was 
the surgical and medical centre of the city. 

A great change was about to come upon the exist- 
ing system of medical education, but the college hardly 
knew it. The men at the hospital did. They knew 
that the learned essays, the eloquent harangues must 
give way to colloquial instruction in the presence of 
the patient. In these days the colleges have learned 
that medicine and surgery cannot be taught like law 
and theology. They are fast becoming vast dispen- 
saries, dissecting-rooms, and laboratories. The science 
and practice of medicine are taught by facts and not 
by theories. Tn these quiet times in the medical New 
York of som.e fifty years ago, there was but one dis- 
pensary, and that was scarcely ever used by students. 
There was an occasional invitation to an operation in 
the small amphitheatre in the hospital. There w^ere, 
however, brilHant triumphs in surgery; triumphs that 
made American surgery famous, and which will make 
doctors talk of the surgeons of those days as long as 
they talk of anything. 

There were also excellent and wise general practi- 



240 MEDICAL NEV/ YORK— OLD AND NEW. 

tioners. They had no thermometer, but the tactics 
eruditus stood them in good stead, and they often 
made prognoses that we who are reHant upon instru- 
ments of precision might envy. 

" Far from the madding crowd's ignoble strife 
Their sober wishes never learned to stray." 

Unambitious beyond the ambition to serve their 
patients, they reverently consulted the treatises of the 
fathers, or the essays and cases of their contemporaries 
across the sea. In those days a New York doctor had 
no idea of writing a book, perhaps not even of report- 
ing cases in print. At the very most, he might contrib- 
ute reports of his cases to one of the few journals, 
but if of a literary turn of mind he contented himself 
with editing the work of an Englishman or of a 
Scotchman, or perhaps he translated some French 
writer. Almost with bated breath did these men, 
some of whom are worthy to be compared with the 
best of our time, speak of the medical men of the old 
world, separated from them as they were by not only 
thousands of miles of sea, but more than all, by lack 
of opportunity for mutual intercourse, for self-instruc- 
tion, such as London and Paris gave in good measure. 
Little did they think of the day of the Flints and 
Dalton, Sims and Thomas, of Emmet, Hammond, 
Jacobi, Hamilton and Barker and Sayre, and many 
others, of the time when American text-books are 



MEDICAL XEV/ YORK— OLD AXD XEW. 24 1 

on every table in trans-atlantic medical libraries, and 
are quoted at every lecture in European clinics. 

In those times the doctors knew each other not 
only by name, but so well as to enjoy a joke at the 
expense of one another's personal characteristics. 
They stopped each other on the street and talked of 
the weather and the politics of the day. Indeed 
Hosack and Francis interested themselves in all the 
social and literary affairs of the time. At Xo. i Bond 
Street was a drawing-room whose Saturday evenings 
attracted the wits of the town, as well as those who 
might be temporarily in New York. That age was 
not all golden, however. There was opportunity for 
envy and cabals, for gossip and slander. The medical 
profession then as now was somewhat belligerent, and 
not always in a good cause. There was too much reli- 
ance upon foreign opinions, too little upon the great 
authority, the exact and intelligent study of the pa- 
tient himself. While we have necessarily lost some of 
the restful attributes of life in a small town, the life 
among medical men is on the whole broader and better 
than it was fifty years ago. In these changes for the 
better New York easily takes the lead as a metropolitan 
city should. Even in her code of ethics she has, during 
the last year, unlike her sister medical cities, taken a 
step which shows that she believes the conduct of a gen- 
tleman cannot be defined by a set of rules. 

The steamship, the railway, the telegraph, and the 
16 



242 MEDICAL NEW YORK— OLD AND NEW. 

telephone have made changes in medical as well as 
commercial New York. Depau Row is no longer up 
town nor is Chambers Street the centre. All the sur- 
gical wisdom of the city is not to be found in the New 
York Hospital. The consulting-rooms of our physi- 
cians are now filled with patients from San Francisco as 
well as from Bound Brook and Newtown, and all are 
anxious to get away by the first afternoon or evening 
train. There is no longer a rus in urbe on Manhattan 
Island, since Harlem Lane has given place to St. Nich- 
olas Avenue. 

It is unfortunate for New York, that the business 
men have been the chief ones to recognize this change 
in the city. They are quick to exchange their cargoes 
from sailing ships to steamers, to build immense ware- 
houses, and to connect this market with the others of 
the world by the most expeditious means. They at 
least know that New York is no longer a rival of New- 
port. But New Yorkers have been slow to learn that 
their city has become an educational as well as a com- 
mercial metropolis. 

Some years ago I attended a public dinner in this 
city, at which one of the speakers was the mayor. 
The dinner was given by the alumni of one of our 
medical schools, and the chief subject of discussion 
was the advantages offered by the metropolis in the 
way of professional study. In the mayor's speech, he 
expressed some surprise that New York should be 



MEDICAL NEW YORK— OLD AND NEW. 243 

thought to be anything more than a commercial town. 
This mayor was one w^ho stands high among his pre- 
decessors and successors in character and intelhgence. 
He had taken an especial interest in educational mat- 
ters, and yet it was a new idea to him that New York 
perhaps might be, or already was, a university centre. 
But it is not strange that the chief official of this 
city took such a view. Our public men have not been 
educated to take any other. In Boston, when Presi- 
dent Eliot wants a hundred thousand dollars for 
Harvard College, he walks down Beacon Street, and, 
without pulling a door-bell, he finds the son of a Puri- 
tan who will give it. In Philadelphia, the new provost 
of the university calls together the best representa- 
tives of the city to aid him in the management of his 
great charge, and he finds everywhere sympathy and 
support. In Boston, no rich man can be properly 
buried who has not left some money to Harvard Col- 
lege, the Medical School, a hospital, or the Institute 
^ of Technology. In New York, half a dozen men, with 
money enough to endow Columbia College and the 
University, besides creating a thousand free beds in a 
hospital, die in one year and do not mention New 
York in their wills. It is the great stamping-ground, 
however, for the man who wishes to plant a new de- 
nomination in a parish already having one to each 
fifty people. Peripatetic presidents of Tuscaloosa 
and Oshkosh Universities wander about from one 



244 MEDICAL NEW YORK— OLD AND NEW. 

banking-house and private dwelling to another and try 
to enlist the sympathies of every moneyed man in the 
community. And at public dinners of the academic 
institutions, where there are a hundred men who have 
acquired their professional education and have made 
fame and wealth in New York, the collection-box is 
passed about again, till New York charities and pro- 
fessional schools are in despair at any recognition of 
their claims. 

I have heard New York accused of a want of civic 
pride. Be this accusation just or not, she has cer- 
tainly not appreciated her great position as a place 
for extra academic, for professional, or, as I prefer to 
say, for university study. For example, the Univer- 
sity of the city, founded with a broad and comprehen- 
sive charter by men whose ideas were far ahead of 
their time, now that her opportunity has come, chooses 
to hug her feeble little college, rather than lift on her 
strong arms the noble university that rightfully be- 
longs to her. In her professional schools of law and 
medicine, in the addition of others, is her great work, 
for New York parents have long since resolved that 
college boys are better off in New Haven, Princeton, 
and Williamstown than in a vast city. 

Columbia College was very loath to begin her scien- 
tific school, now one of her chief glories, and she is 
very slow indeed to use her enormous advantages of 
wealth and renown for that which is her great future. 



MEDICAL XEW YORK— OLD AXD XEW. 245 

The medical school of that college contains, perhaps, 
twice as many students as does the academic depart- 
ment, and yet it remains unconnected with it except in 
name. The school of law also out-numxbers the un- 
dergraduate department, while its fame is as wide as 
the limits of the nation. 

New York has not kept pace with the small towns 
in the number of her undergraduate students, or in 
the reputation of her colleges, but her professional 
schools have been for fifty years growing in magnitude 
and importance. New York now has more than two 
thousand medical students. Her hospitals and dispen- 
saries have increased until they can scarcely be named 
off-hand. Yet the medical colleges continue to be 
private and proprietary institutions. Their teachers are, 
I believe, among the best of our country and worthy of 
any country. But while Boston and Philadelphia are 
making vast strides in improving the methods of instruc- 
tion. New York is obliged, from lack of endowments, 
to hold on to the old plan. Those who have studied 
one, two, and three years sit upon the same benches, 
hear the same lectures, and crowd the same wards and 
amphitheatres. There is no matriculation examination, 
and, unless in exceptional cases, but one final one at 
the end of three years, of what is in some cases merely 
nominal study. Graduates in medicine, who came 
here for special study, so far as they heard lectures at 
all, heard the same that were given to undergraduates 



246 MEDICAL NEW YORK— OLD AND NEW. 

under the conditions I have described. In fact, the 
changes of the time have not been appreciated by the 
educated and wealthy people of New York. Immersed 
in their own affairs, untaught by those who should 
have taught them, so far as they have taken an interest 
in educational matters, it has been chiefly in public 
schools and colleges, while professional institutions 
have scarcely been observed by them. Medical men 
have been remiss in not educating their fellow-citizens 
upon these subjects. Although medical teachers have 
been enlarging their curriculum and increasing the 
number of their teachers in the colleges, the growth 
has been chiefly at the top and not at the foundation 
of the structure. No fundamental changes have as 
yet been made in New York medical colleges. 

What relation has our present enterprise with a 
reform in medical instruction in our city ? Certainly 
it has nothing to do with undergraduate reforms. 
However much as individuals we may be interested in 
such changes as shall cause a New York medical 
diploma to be evidence of fitness to practice, the school 
which we inaugurate to-night has nothing to do with 
this subject. Our object is not to make more doctors, 
but to improve those we have. We propose to make 
a centre in which it will be possible for a graduate in 
medicine to fit himself for the detection and treatment 
of the diseases that are not fully discussed in the 
studies and lectures of the ordinary course of three 



MEDICAL NEW YORK— OLD AND NEW. 247 

years in a New York medical college. It is true that 
the various subjects upon which our lectures and de- 
monstrations are given are treated upon in these 
schools. There is a weekly lecture upon most of the 
subjects, besides, in the course upon medicine, surgery, 
obstetrics, anatomy, there are incidental allusions, 
more or less full, which, if availed of, give the graduate 
a general knowledge of what have come, rather un- 
fortunately as it seems to me, to be called specialties. 
But, and it is this hit which furnishes a reason for our 
existence, there is no such knowledge furnished as will 
enable a man to recognize and successfully treat many 
of the common ailments of men and v/omen. Even a 
hospital training of from one to two years, w^hich un- 
fortunately but a small proportion of our graduates 
are able to secure, leaves many subjects practically 
untouched. Honest practitioners confess at once, 
with much embarrassment, their lack of knowledge, 
much more of experience, in many cases, and, if pos- 
sible, ignore their existence when they cannot send 
them to men whose opportunities in these departments 
have been sufificient. Many others, equally honest, liv- 
ing in places remote from large towns, seek by means 
of text-books and their knowledge of the general 
action of disease, to do what they can, but even these 
must leave much untouched. If proof of this state- 
ment be desired, it is easily furnished in the crowded 
clinics of the medical colleges of small towns. There 



248 MEDICAL NEW YORK— OLD AND NEW. 

patients are furnished by the score or even hundred, 
who await from year to year the arrival of special pro- 
fessors who have been chosen to supplement the reg- 
ular faculty. 

Many practitioners come to New York every year 
to acquire the practical knowledge of diseases called 
special, but which they find to be very general, and 
of which they were taught very little in their fifteen 
months of attendance upon lectures. What can they 
do? They may matriculate at any of our colleges, and 
in the dissecting-rooms, if it be anatomical knowledge 
they desire to supplement, the facilities are ample and 
excellent. Of late years, too, the dead-houses have 
also done much to instruct the general practitioner. 
He can, besides, with some trouble of inquiry and run- 
ning about, find special courses in diagnosis, where ex- 
perts will furnish excellent practical teaching. If, 
however, he seeks in the lectures upon special subjects 
in the colleges that which he must acquire in a short 
time or not at all, he finds himself baffled and disap- 
pointed. He soon finds that these weekly lectures and 
demonstrations are for those who have no practice be- 
hind them, whatever may be before, for those who have 
the whole five months of the session at their disposal. 
Besides, the classes are so large, that only the early and 
persistent men on the front benches have an opportu- 
nity to study the cases with the teacher. Even for 
those who find the courses they desire in the dispen- 



MEDICAL NEW YORK— OLD AXD XEW. 249 

saries and hospitals, the difficulties are by no means 
insignificant. There is no central place where they 
may find what they desire. This centre we hope the 
New York Post-Graduate Medical School m_ay furnish. 
But it may be said that existing medical schools should 
furnish these facilities. This we fully admit. At least 
the corporation, which should be at the back of the 
teachers, should have a post-graduate as well as an 
undergraduate school, or the course should be length- 
ened to include it. This is the ideal medical depart- 
ment of a university. But ideals are not always to be 
obtained. Certainly this ideal is not yet to be obtained 
in New York. A man who quarrels with the inevita- 
ble is not wise, but he may flank a difficulty. He may 
not be able to a;et out of the wet, but he mav wear a 
Macintosh and carry an umbrella. I think the colleges 
would be greatly the gainers b}' this enlargement of 
their scope. But as proprietary institutions, without 
an interested corporation to sustain them, and without 
invested endowments, they believe that undergraduate 
instruction is all they can properly undertake. It 
would be easy to show that Berlin and Vienna have 
acquired their preeminence as medical centres, not by 
teaching undergraduates, but by the instruction fur- 
nished to medical men. The practitioners who have 
spread the fame of Helmholtz and Virchow, Traube 
and LudAvig, Langenbeck. Arlt, Graefe, Skoda, Braun, 
Oppolzer, Politzer, and Gruber have been in large 



250 MEDICAL NEW YORK— OLD AND NEW, 

measure graduated physicians, who have sat at the 
feet of these great teachers after their fundamental 
studies had been finished. 

A few weeks ago your speaker had the opportunity 
of looking over the new building of the famous school 
of medicine of the University of Edinburgh. Nothing 
can exceed the excellence and grandeur of the arrange- 
ments for the study of anatomy, physiology, and so 
forth, as exemplified in the new structure of this re- 
nowned and in some respects model university. My 
guide, one of the instructors, said to me, " What we 
need now in Edinburgh to attract the men who go to 
Germany, are better provisions for graduates. In that 
we are deficient. For that cause we are losing, and 
have lost some of our proper fame." If this be true 
of Edinburgh, how much more true of New York. 
This city of ours stands without a successful rival in 
the country in the opportunities she can furnish to the 
medical student. This statement may seem a trifle 
strong to our neighbors in Boston and Philadelphia. 
I will, however, leave the students who have seen the 
advantages offered respectively by these cities to jus- 
tify my statement. New York is now, and, unless 
some great disaster overtake her, is destined to con- 
tinue to be the commercial metropolis of the Western 
world. If common wisdom direct the beneficence of 
her citizens, if her civic pride can be aroused, in spite 
of Baltimore and the Johns Hopkins, New York will 



MEDICAL NEW YORK— OLD AND NEW. 25 I 

be the university centre of America. In devotion to 
this chief city of my native Empire State, I have felt 
for years that it was my duty, which nothing can deter 
me from, to cry aloud as to the importance of effort 
which shall one day accomplish this end. 

" May I never 
To this good purpose that so fairly shows 
Dream of impediment." 

The elements which are yet to be fused to this form 
are all about us. That our school may be one of the 
agencies in continuing and securing our intellectual 
preeminence is the earnest desire of those whom I 
have the honor to represent. We cannot believe that 
it will always continue in its present detached condi- 
tion. Our aspirations are far beyond those of a school 
whose affairs are controlled by those who should be 
busied chiefly with teaching. It will yet be a part of 
a great university. 

Circumstances over which we have no control have 
compelled us to add another unendowed school of 
medicine to those that now exist. But we have no 
idea that it will remain so. When we have demon- 
strated our usefulness and the necessity, we shall seek 
an endowment at the hands of our fellow-citizens. 
We believe that we shall see the day when New York 
will first nourish her own children before she is gener- 
ous to others. We also believe that the governing 



252 MEDICAL NEW YORK— OLD AND NEW. 

bodies of our universities will yet make them so in fact 
as well as name, that medical colleges will become an 
actual part of them and that then the post-graduate 
medical school will have its appropriate place in the 
third and fourth years of study. Not division, not 
separation, but unity in university instruction is what 
we seek, and what we believe our institution will ulti- 
mately promote. We shall belittle our power and fail 
to exert our proper influence, if we do not all, mer- 
chants, lawyers, clergymen, and physicians, soon recog- 
nize the fact that not even Prague in the thirteenth 
century, when thousands of students came to her halls 
on the banks of the Moldau, had a better claim to be 
a university town than New York has in the nineteenth. 

London has not been wise in dividing her medical 
profession into a large number of medical schools. 
Some of her influence has been lost on this very ac- 
count, and I speak, not from the superficial opinion of 
Americans who have visited and studied in the metro- 
polis, but I give the deliberate judgment of one of her 
most successful and eminent practitioners who has 
lately visited New York. 

Paris, Berlin, and Vienna have obtained their 
enormous power over medical action and thought, in 
part, at least, because the faculties of their great uni- 
versities have comprehended nearly all the men in the 
cities who have been competent and willing to teach 
medicine. There has been concentration of effort at 



MEDICAL NEW YORK— OLD AND NEW. 253 

one centre. For that consummation, I earnestly hope 
for New York. 

Within the memory of many of us, Italy, dissevered 
and separated into petty kingdoms, has been united 
by the patient genius of Cavour, and now she is a 
united and powerful country. 

Germany also, by '' blood and iron," has again be- 
come a nation, and her power in the councils of the 
world greatly increased. 

I trust there will arise for our beloved city of New 
York, not a Cavour or Bismarck, but such a wise under- 
standing on the part of her citizens that they shall with 
one accord strive for a unity of plan and action which 
shall unite all her scattered, unknowQ, and undeveloped 
energies, and cause her to be everywhere recognized 
and resorted to, as the great university centre of our 
side of the Atlantic. 



JAMES LAWRENCE LITTLE, M.D. 



X. 

JAMES LAWRENCE LITTLE, M.D., 
A Sketch of his Life and Tiviesr 

James LA^VRE^XE Little was born of Scotch-Irish 
and English ancestry, in the city of Brooklyn, February 
19, 1836. He attended private school in his native city 
until he was about tAventy years of age, when he at- 
tempted to become a book-seller, and to this end was 
engaged as a clerk in a Fulton Street establishment 
kept by Mr. Riker. The firm that employed him had 
a stock of medical books as well as of general litera- 
ture. The young clerk was soon so deeply immersed 
in the study of these books that he proved a ver}* in- 
efficient salesman, and he gave up his attempt in 
business. 

This inclination to the study of medicine had already 
been seen in young Little when he was a micre boy. 
After much cogitation as to the ways and means of 
getting a skull for the purpose of study, he finally ap- 
proached a venerable African grave digger, Avho con- 
sented to furnish him with the desired relic, if he would 

■^ Read before the Xev.' York Academy of Medicine, Xovember 5, 1S35. 
17 



258 JAMES LA WRENCE LITTLE, M.D. 

bring twenty-five cents and a paper to wrap it in. 
Little secured the treasure on these terms, and return- 
ing home, took a peep at it, and, to his youthful hor- 
ror, found that it was an unprepared skull looking 
upon him in the ghastly covering of facial integument 
and scalp. Fear got the better of his anatomical en- 
thusiasm, and seeking a plan to get rid of what was 
now a source of dread at its horrible aspect, as well as 
of fear lest he might be found with such an unexplain- 
able object upon him, he threw it into the waters of 
Wallabout Bay, and postponed his medical studies for 
a season. 

After leaving the bookstore, Little entered the 
office of Dr. Willard Parker as a private student, and 
at the same time he matriculated in the College of 
Physicians and Surgeons. After Dr. Little had be- 
come a distinguished surgeon, Dr. Parker gave the 
writer an account of how he nearly rejected him when 
he applied for entrance to his already crowded rooms. 
He was at first disposed to decline to receive another 
student, but he was impressed by the great earnest- 
ness of the tall and handsome young man, and he con- 
sented to take him. '' But," continued Dr. Parker, 
*' I never had occasion to regret my decision. Punctu- 
ally as the clock struck nine, the click of the young 
man's boots was heard upon the doorstep, and I got 
to recognize his step and to count upon him, whoever 
failed." The word click aptly describes the short and 



JAMES LAWRENCE LITTLE, M.D. 259 

quick step, that many of Dr. Little's contemporaries 
will recall as one of his personal characteristics. 

After being in Dr. Parker's office more than two 
years, he successfully passed a competitive examina- 
tion, and was appointed a junior assistant in Bellevue 
Hospital. This appointment did not take effect until 
the following spring. Meanwhile, in March, i860, he 
was graduated at the College of Physicians and Sur- 
geons. He then resigned his position at Bellevue, and 
after examination he was appointed junior assistant 
in one of the surgical divisions of the New York Hos- 
pital. A resignation of a place in one hospital to take 
a similar one in another, was something unusual, and 
it was said at the time that it caused a little unpleasant 
feeling among the staff at Bellevue, for Dr. Little was 
well known to some of them, and to James R. Wood 
in particular, as a promising man whom it was not 
well to lose. 

Bellevue Hospital was just coming into some im- 
portance as a school of surgery, and chiefly through 
Dr. Wood's clinics and his prizes for anatomical prep- 
arations offered for competition among the medical 
schools. Yet at that time it could in no manner com- 
pare with the New York Hospital in furnishing oppor- 
tunities to a surgical student. It was an institution 
belonging to the city, receiving only paupers to its 
wards, and it was governed by politicians. It had 
much more importance as a school of medicine than as 



26o JAMES LA WRENCE LITTLE, M.D. 

one of surgery. John W. Francis was one of its con- 
sulting physicians, and occasionally gave a mellifluous 
and learned address in its amphitheatre, and Alonzo 
Clark, John T. Metcalfe and Benjamin W. McCready 
held clinics in the wards, while on Saturdays there 
was a great crowd of students to witness the rapid and 
skilful surgical operations of the renowned pupil of 
Valentine Mott, James R. Wood. Certainly any young 
doctor in medicine might have been honored by en- 
trance into such a hospital. But the New York Hos- 
pital was a wealthy and private corporation, governed 
by some of the best laymen in the city, and, more than 
all, it was one of the most renowned schools of surgery 
in the world. In its amphitheatre Wright Post, and 
Kearney Rodgers had won their fame, and there Val- 
entine Mott, who was still living and lecturing upon 
surgery, had tied the artcria innominata. Mott was a 
consulting surgeon with Alexander H. Stevens, John 
C. Cheesman, and Alfred C. Post. Of these but one 
now remains, an honored link to connect us to the 
medical New York of fifty years ago." The active 
members of the surgical staff were Gurdon Buck, John 
Watson, Thaddeus M. Halsted, Willard Parker, Will- 
iam H. Van Buren, and Thomas M. Markoe. Of this 
number but one now survives, and he happily in full 
vigor of mind and body. The old hospital was situated 

* Dr Post also died in February, 1886, a few months after this was 
written. 



JAMES LAWRENCE LITTLE, M.D. 26 1 

on Broadway, facing Pearl Street, on ample grounds, 
nearly surrounded by grand old elms. Its beautiful 
lawn, upon which tame deer might often be seen, was 
a surprise and delight to the strangers in New York, 
who came suddenly upon this break in the monoton- 
ous business buildings of a great city. 

The house staff was in a traditional state of excel- 
lent discipline. Its members vied with one another in 
their care of their cases, and their dressings of frac- 
tures and ulcers were at once the delight and dismay of 
medical students who followed the attending surgeons 
about the wards. It was not strange, then, that young 
Little, especially when urged by his preceptor, resigned 
his place in a hospital which had no past, for one 
whose annals, twenty-five years ago, were more full 
than perhaps any hospital in the land. 

In April, i860, Dr. Little began his duties at the 
New York Hospital as a junior walker. In April, 
1885, he died. Hence, it may be truly said, that a 
quarter of a century bounded his professional career. 
What a twenty-five years it has been for medical and 
surgical science in New York and in the world ! There 
were then three colleges, and perhaps eight hundred 
students and practitioners attending lectures in the 
College of Physicians and Surgeons in Twenty-third 
Street, the University in Fourteenth Street, and the 
New York Medical College in Thirteenth Street. 
Bellevue Hospital Medical College existed only in the 



262 JAMES LA WRENCE LITTLE, M.D. 

embryo of its medical clinics and James R. Wood's 
exploits on Saturday afternoons. Clinical instruction 
was in its infancy, and there were but two hospitals, at 
long distances from the colleges, where it may be said 
to have existed in a meagre way, and then, except 
when a great operation was to be performed, to be at- 
tended by not more than a score or so of the students. 
Now, there are added to the New York and Bellevue, 
the great Charity Hospital on the Island, St. Luke's, 
the Roosevelt, the Presbyterian, Mount Sinai, and St. 
Vincent's; these are all more or less used for clinical 
teaching, and two thousand or more students and 
physicians attend the lectures of the three colleges of 
our faith, the College for Women, the Post-Graduate 
School, and the Polyclinic. 

Among the most widely known of the teachers at 
the Colleges were Parker, Oilman, Watts, St. John, 
and Joseph M. Smith, in Twenty-third Street ; John 
William Draper, Bedford, Paine, Van Buren, Post, and 
Metcalfe, at the University; Horace Green, Fordyce 
Barker, Ogden Doremus, and Carnochan, in the New 
York College; while George T. Elliot, Charles A. 
Budd, Loomis, Jacobi, Thomas, Sands, Sayre were, as 
would be said in Edinburgh, extra mitral teachers, 
who were nearly within the walls. So great have been 
the losses by death in these names, that, as we recall 
them, the words of the Latin poet com.e at once to the 
mind: 



JAMES LA WRENCE LITTLE, M.D. 263 

" Eheu fugaces Postume Postume, 
Labuntur anni." 

When Dr. Little entered the New York Hospital 
the civil war had not broken out, although excited 
meetings of students had been held on account of the 
John Brown raid, and Southern students were being 
pledged not to return to Northern cities for instruc- 
tion. Terrible strife was soon to cause the erection of 
immense hospitals by the medical staff of the United 
States army, from whose records surgical literature 
was to be enriched to an extent not dreamed of by the 
surgeons of this country. The battle fields of Manas- 
sas, Shiloh, Gettysburg, and around Richmond, from 
their awful experiences, were to train a race of men 
which has caused American surgery and medicine to 
take a higher place in the world than would have been 
attained by half a century of work in small civil hos- 
pitals, while the Sanitary Commission was to open up 
a field for the cultivation of sanitary science and of 
active benevolence hitherto unknown. 

When Dr. Little entered the wards of the New 
York Hospital, the thermometer was not generally 
used to show the temperature of the body. The laryn- 
goscope and ophthalmoscope had just been placed in 
the hands of a very few specialists, but they were not 
at all employed in the New York general hospitals. 

There was but one hospital of any considerable im- 
portance for diseases of the eye and ear, and that had 



264 JAMES LAWRENCE LITTLE, M.D. 

not one-half the number of patients it now has, al- 
though three similar institutions have been added to 
the charitable and educational resources of the city. 
There were no training schools for nurses, and scarcely 
any trained nurses worthy the name. Those whom we 
had were chiefly males, with a strong preference for 
alcohol as a stimulant, who had been promoted from 
being patients to be nurses, while the women, in many 
instances, had been scrubbers in the wards over which 
they presided. Not but that there were some excel- 
lent nurses in those days, however. Pyaemia, erysipe- 
las, and hospital gangrene were then dreaded foes, and 
antiseptic surgery, if practised in attempts at absolute 
cleanliness, was not understood as now, when patients, 
after operations, are saved, not as by fire, but as a 
matter of course. Marion Sims had just read his 
famous paper before this Academy upon silver sutures 
in surgery, and was about to found the Woman's Hos- 
pital, with Emmet as an assistant, and become the in- 
tellectual progenitor of men who with him created 
modern gynecology. All this Dr. Little saw, and in 
much of it he was an active participant. 

New York, in i860, had tv\^o or three medical jour- 
nals, not of extended circulation, while an Ishmaelitish 
scribbler or two issued monthly bulletins in a style of 
medical journalism now happily extinct. There were 
two medical bookstores, called publishing houses 
rather by courtesy than as a matter of fact, for scarcely 



JAMES LA WRENCE LITTLE, M.D. 265 

a New Yorker but Bedford and Dalton and Draper 
had written a medical book, and very few had even 
edited or translated one. New York scarcely claimed 
equal rank with Philadelphia as a medical centre. 

Now, New York boasts of three publishing houses 
where American medical books are issued, and that in 
considerable number. Her medical journals are more 
widely circulated than those of any other city in this 
country, and they are to be found by the side of the 
works of American medical men upon the library tables 
of the physicians of every nation. 

In the hospital Little gave promise of his future 
career. He was assiduous and faithful as an assistant, 
and suggestive and enthusiastic as a house surgeon. 
His humorous contemporary, Dr. Samuel W. Francis, 
remarked of him that even then there was uniltiun in 
parvo. He reported many of the cases occurring in 
the wards in the American Medical Times. It was 
while in the hospital that he devised his method of 
making and applying plaster of Paris splints. It is not 
too much to say that chiefly, if not entirely, through 
Little's efforts plaster of Paris splints became a practi- 
cal application. Until then, although much recom- 
mended, experience had shown that it v\-as not well 
adapted for a surgical dressing. Little saw in plaster 
of Paris a material which, if properly used, would form 
that so much to be desired, an immovable and yet 
porous splint. Those of us who were associated with 



266 JAMES LA WRENCE LITTLE, M.D. 

him remember his painstaking trials in preparing the 
plaster, in securing the proper consistency, and the 
material best adapted to take up the solution, the dis- 
appointment and failures until a splint was produced 
which convinced his colleague, the house surgeon of 
the other division, and the attending surgeons, that 
the days of the starch apparatus — a favorite bandage 
of the hospital — were past. In using plaster of Paris 
as a splint instead of a bandage, he utilized the material 
as never was before done, and although it is possible 
that it will never have a widespread use just as Dr. 
Little employed it, he gave an impetus to the subject 
which was perhaps the origin of the famous plaster 
of Paris jacket. His paper upon the subject may be 
said to be classical."^ 

During the civil war, on several occasions, Little's 
services were furnished to the Government. He was 
for a time surgeon-in-chief to the hospital erected on 
the edge of the City Hall Park, and twice, at least, 
after great battles, he volunteered with those other 
New Yorker surgeons who went to the front at the 
call of Surgeon-General Hammond. Now, as then, 
the avenues to professional success as a teacher and 
consultant began at service in dispensaries and clinics. 
Dr. Little was engaged in such work from the days 
when he was a medical student and a substitute for the 

* Transactions American Medical Association, 1867, Medical Record, 
1874. 



JAMES LA WRENCE LITTLE, M.D. 26^ 

junior walker in the hospital until his death. One 
year after leaving the hospital he was appointed clini- 
cal assistant to Dr. Parker, who was then Professor of 
Surgery in the College of Physicians and Surgeons. In 
1863 he was appointed a Lecturer in the College. His 
first course of lectures was upon '' Fractures and their 
Treatment." These lectures were continued until 
1868, when his chair was enlarged to that of ''Opera- 
tive Surgery and Surgical Dressings." 

Dr. Little was very popular as a lecturer. His 
manner was exceedingly simple, in fact, at first dis- 
tressingly so ; but it was earnest, and devoid of man- 
nerisms and self-consciousness. One of our most suc- 
cessful teachers lately said to me, '' Little did not 
merely tell the men to apply a flaxseed poultice, but 
he brought the flaxseed and the cloth to the lecture- 
room and made the poultice before the class. Then 
they knew how it was done for they had seen it." In- 
deed, his teaching was realistic to a degree. The man 
was thoroughly in love with his work. He was alive 
to every progressive tendency; he travelled in no rut, 
but was always on the alert to assist in making surgery 
the exact science it is so fast becoming. He took 
great pains with the illustration of his subject by dia- 
grams and drawings, which were prepared by compe- 
tent men under his directions with great care. An 
examination of his library after his death showed that 
he had ransacked the surgical pictures of Great Britain 



268 JAMES LAWRENCE LITTLE, M.D. 

and the Continent to secure the best illustrations for 
his lectures. Certain it is, that not a little of the fame 
of his alma mater for thorough teaching was due to 
Dr. Little's lectures, although they were given in the 
summer term, and attendance upon them was not obli- 
gatory. They were continued for sixteen years, when 
he resigned from the position he held in the college as 
a lecturer on surgery, and as one of the staff of Pro- 
fessor Markoe — who had succeeded Parker — and ac- 
cepted the appointment of Professor of Clinical Surgery 
in the University of New York. 

But Little's best qualities as a surgeon, a teacher, 
and an executive officer were seen after his appoint- 
ment to the chair of surgery in the University of Ver- 
mont. This was in 1875. He had previously declined 
an offer of a similar chair in the Long Island College 
Hospital. He entered upon the work in Burlington 
with great zeal. There he found a medical college 
that still survived the vicissitudes of forty years, al- 
though those at Woodstock and Castleton, in the same 
State, had been abandoned. It had about sixty 
students. Little's keen perception of the possibilities 
of this field showed him that they were great. The 
lately elected President of the University, Dr. Buck- 
ham ; the venerable Carpenter, professor of practice; 
with Thayer of anatomy. King of obstetrics, and, 
Darling of anatomy, were fully alive to what lay in 
store for the Burlington Medical College. There was 



JAMES LA WRENCE LITTLE, M.D. 269 

a reason for the existence of a medical college there. 
It was needed to supply the demand for medical edu- 
cation for a large number of young men from Vermont 
and Northern New York, who could not conveniently 
go to Boston, Philadelphia, or New York. 

The academical department, at the laying of whose 
corner-stone Lafayette had assisted, embraced in its 
faculty many soundly educated and cultured men, 
whose sympathies were readily enlisted for any good 
scheme for the cultivation and dissemination of human 
knowledge. They seconded the efforts of the presi- 
dent to give character to the various departments. 
The medical school acquired a certain dignity by its 
name, and it had that not unimportant advantage over 
the schools that formerly existed in the same State. 
Many young men, exceptionally well prepared by pre- 
vious training, found it more convenient to study in 
Burlington, on account of the greater e:Kpense attend- 
ing a long stay in a large city; and many practitioners 
of Vermont and Northern New York found the clinics 
and lectures of the medical department of the Uni- 
versity an accessible post-graduate school, which 
lighted up many a dark subject, and gave them a little 
recreation from their lonely and responsible duties as 
country physicians. The professor who went to Bur- 
lington from a metropolitan medical college, soon saw 
that he had as intelligent and as earnest listeners as at 
home, and that he must relax nothing in his efforts to 



270 JAMES LA WRENCE LITTLE, M.D. 

teach his science and art. With the hearty co-opera- 
tion of the President of the University, who presided 
at all the faculty meetings, and his own colleagues. 
Professor Little immediately began to devise plans for 
increasing the fame and usefulness of the school. By 
personal solicitations in many instances, he was largely 
instrumental in securing courses of lectures and clinics 
upon subjects not fully, if at all, embraced in the gen- 
eral curriculum, by specialists from colleges in our 
city. Then, Miss Mary Fletcher, acting largely upon 
the advice of President Buckham and Professor Car- 
penter, founded a hospital, and with a broad minded- 
ness not always seen in those who found hospitals, 
gave up its wards unreservedly to the teachers of the 
college. This was naturally of the greatest importance 
to the success of the school, for the day had passed 
when didactic lectures, unillustrated by subjects, were 
considered fit means of teaching medicine and surgery. 
Little's facilities for the performance of great opera- 
tions were largely increased by the foundation of the 
hospital. His clinics were sought by crowds of patients 
from far and near. During the weeks that he lectured 
in Burlington, the streets of the city gave evidence, by 
the passing through them of numerous people with 
surgical dressings on some part of the body, and by 
the great accumulation of the m.ud-stained buggies of 
the practitioners of the adjacent towns, as well as by 
the over-filled wards of the hospital, that a great deal 



JAMES LAWRENCE LITTLE, M.D. 2/1 

of surgical work was going on. Stimulated largely by 
Little's surgical feats, and by an executive capacity 
heretofore, from the want of an arena, not known to 
belong to him, the college grew apace in character, 
importance, and in the number of students. A new 
building was given to the faculty in 1884, by the late 
Mr. Howard, and when Dr. Little died, more than two 
hundred and twenty students in the class-rooms of the 
college mourned the loss of their professor of surgery. 
In an address commemorative of Darling and Little, 
Professor A. F. A. King sketches the introduction of 
the latter to the class in a manner so graphic and de- 
scriptive of the man that it is here reproduced. Dr. 
King says: '' I introduced him to the class, and I well 
remember his modest embarrassment, which would, 
however, have passed unnoticed by the students, had 
he not said in the course of his first disjointed remarks, 
' I'm a little nervous, as you see.' But a patient was 
introduced, a diagnosis made, an operation decided 
upon, and a knife handed to Professor Little, and I 
can tell you (as you know) he was not nervous then.'' 

To those of us who knew Little well, it was inter- 
esting to see this preliminary nervousness when a 
great operation was imminent. The quick, short steps, 
the restless tapping of the foot when he was preparing 
for his work, gave little promise of the bold, self-reliant 
man as he stood over the patient, perhaps reeking 
with the perspiration of surgical ardor, but yet with 



2/2 JAMES LA WRENCE LITTLE, M.D. 

steady, skilful hand working in a manner that con- 
vinced any one competent to judge, that a life given 
into his care would be preserved and returned, were 
it among human possibilities. 

In Burlington as in New York, '' Little's luck " be- 
came proverbial, for his operations, from causes that I 
am not able to analyze or define, were pre-eminently 
successful. A well-known surgeon in New York told 
me, in substance, that it was a prevalent opinion in St. 
Luke's Hospital, that it would be safe for Little to cut 
off a foot of an intestine, when another man could 
hardly touch it with a knife; and yet he was defer- 
ential to a fault to the surgical opinions of his peers, 
ready to adopt their suggestions, and to give proper 
credit for them. He was a man who exhibited great 
common-sense as a surgeon. He was not overtrained, 
but he knew how to get at the upshot of a case with- 
out being unduly anxious as to how Esmarch or Lister 
were doing that thing now. 

Dr. Little's chair in the University of New York, 
was never fully satisfactory to him. His clinics there 
were held but for a part of the session, and he taught 
but once a week, although his classes were large, and 
the students, at least on one occasion, petitioned the 
faculty that his instructions might be continued 
throughout the session. The request could not be 
granted, on account of the pressure for time in which 
to give the whole curriculum. Three years after his 



JAMES LA WRENCE LITTLE, M.D. 273 

acceptance of the position, together with six members 
of the former post-graduate facuhy of the University, 
he resigned, in order, in conjunction with them, to 
establish the New York Post-Graduate Medical School, 
To this institution he gave the same hearty effort that 
he displayed in Burlington. His lectures to graduates 
were, if possible, better appreciated than by the under- 
graduates whom he had instructed since his early 
manhood. A doctor was to him a brother. Without 
quite knowing it himself, he acted as if he supposed 
that every man who sought or had acquired the degree 
of M.D. was as eager and honest in the pursuit of 
knowledge with which to save life and mitigate disease 
as he was himself. 

It is said that he always leaned toward.the student, 
and possibly too much, when required to vote upon an 
examination in the faculty at Burlington. This was 
not from any idea of lowering the standard of profici- 
ency, but because he could not be made to understand 
that there were men who regarded medicine as a busi- 
ness, in which they were willing to embark with as 
little capital as could make a fair show. During these 
last three years he exhibited his best qualities of faith- 
ful work, and if, as Dr. Lloyd, one of his former office 
students and valued assistants, says, " he was inclined 
to throw off his work on other shoulders, and less in- 
clined to undertake long and serious operations," on 

account of some grave symptoms in his general health 
18 



2/4 JAMES LA WRENCE LITTLE, M,D. 

it was not apparent to those of his friends who saw 
him only at intervals. The last public work he was 
engaged in was a meeting of the Post-Graduate Fac- 
ulty, on the evening of March 31st, when he appeared 
in his usual health and spirits. At that meeting an 
incident occurred which was characteristic of the man. 
He felt impelled by his judgment to vote, on a ques- 
tion which then came up, contrary to his feelings. It 
was a question that might affect the interests of some 
to whom he was attached, and after he had voted and 
was found to be in the majority, he expressed his re- 
grets that he should be obliged to vote for a policy 
which might prove detrimental to the interests of a 
friend, and he vainly sought for a compromise upon 
the subject. 

Dr. Little's services to St. Luke's Hospital were 
very great, and they were warmly appreciated by his 
patients, his colleagues, and the management. He 
served one term of ten years, from 1868 to 1878, when 
he was retired under the rules to be made a consulting 
surgeon. \\\ 1882 he was reappointed an attending 
surgeon, and held the position until his death. 

Little used to tell a story of an experience of his 
at St. Luke's, which well illustrates the maxim that 
"all men think all men mortal but themselves." He 
was to operate, on one afternoon, upon two cases for 
resection of the upper jaw. The first patient died 
upon the table from getting blood in the trachea, and 



JAMES LA WRENCE LITTLE, M.D. 275 

Little sent word to the survivor that he wished to 
postpone the operation for him. He was very much 
disappointed at the delay, and urgently insisted that 
Dr. Little should personally visit him in the ward and 
tell him why he did not wish to operate upon him as 
appointed. The surgeon accordingly went up, and 
with some hesitation, on account of the probable effect 
upon the hopes of the candidate for an exsection, 
frankly told him that the first man was dead, and he 
did not feel like going on with a case of the same kind 
just at the moment. But instead of being daunted the 
patient exclaimed, "Oh, that's nothing! I'm not 
afraid. The other man was a sickly fellow. I never 
thought he would get through. You operate on me, 
I won't die." As a matter of fact Little did soon 
operate upon him, he got no blood in his trachea, and 
he did not die. 

In 1876 Dr. Little was appointed an attending sur- 
geon to St. Vincent's Hospital, a position which he 
held when he died. Little always believed, that the 
kind offices of the Rev. Vicar-General Quinn, one of 
the managers of that hospital, were largely instru- 
mental in securing him this position. The Vicar-Gen- 
eral was a priest in the ranks when Dr. Little was 
house surgeon in the New York Hospital, and in his 
visitations to the sick and dying in the wards, had been 
struck by the commanding presence, the assiduous and 
faithful labors of the young surgeon. 



276 JAMES LA WRENCE LITTLE, M.D. 

Of Dr. Little's surgical achievements in detail, I 
am not competent to speak, nor is it necessary that I 
should do so. They are indelibly recorded in surgical 
literature — at least in part, for of late years Dr. Little 
was somewhat regardless, from lack of time, perhaps, 
from his large and exacting public and private prac- 
tice, to write as much as his friends might have wished. 
But I may say that he was the first American surgeon 
to puncture the bladder with the aspirator, for the re- 
lief of retention of urine. He simultaneously ligated 
the subclavian and carotid arteries of the right side, 
for aneurism of the first part of the subclavian. The 
operation for stone by various methods he had per- 
formed seventy-seven times, with a fatal result in but 
two cases. In hare-lip and strangulated hernia he also 
had a large and successful experience. 

He entered into the advances claimed to be made 
in antiseptic surgery with great enthusiasm, and on 
his last visit to Europe, at the meeting of the Inter- 
national Congress in London, he investigated Lister's 
methods very carefully, and came back to carry out 
all the details of Listerism in capital operations. 

He was a surgeon who looked round upon a far 
horizon. Very few operations were foreign to his 
knife. Yet he was extremely appreciative of special- 
ists, and while not needing their advice as much as 
some of those who have looked askance at them, he 
frequently sought their aid, and often publicly recog- 



JAMES LAWRENCE LITTLE, M.D. 2JJ 

nized their value in enlarging the field of exact knowl- 
edge. He himself used the ophthalmoscope, the 
laryngoscope, and other means of examination not 
always used by general surgeons, so that he was sing- 
ularly competent to make an examination in any sur- 
gical case. In the practice of medicine also — for he 
by no means confined his work to surgery — he w^as 
suggestive in the matter of treatment, and had many 
celebrated prescriptions upon which he drew with 
great readiness and accuracy. 

Little was a great admirer of his instructor, Wil- 
lard Parker. He gave his first-born the name of 
his preceptor. Dr. George Shrady styles him one of 
his worshippers. So great was this admiration when 
he left the hospital, that some of his friends feared he 
would be content to be an imitator and never strike 
out for himself. But he had Dr. Parker's art of mak- 
ing surgery fascinating to students ; he drew them 
about him in great numbers. Even if the clinical ma- 
terial for his hour, on any particular day, was scanty, 
the lecture would not betray the want, for what was 
there was made the subject of homely but important les- 
sons. The capacity for dignifying the everyday work 
of surgical practice, for making apparently minor things 
and details assume their true importance, belonged to 
him in a great degree. He could make a good clinic 
from material which some surgeons would not deign 
to spend a moment upon. Like Willard Parker also, 



2^8 JAMES LA WRENCE LITTLE, M.D. 

he attracted to himself numerous office students, who 
almost invariably became much attached to him. 

Dr. Little was, in the good sense, a simple-minded 
man. He loved to sit down in such places as the office 
at the hotel in Burlington, and, as he became warmed 
in his discourse, talk to plain laymen, who understood 
but half of what he said, of tumors and ligations, of re- 
sections and ovariotomies, and all without any idea of 
boasting of his own deeds, for he had not the faintest 
resemblance to a braggart, but he was so interested in 
surgery that, like Agassiz, who talked about his study 
of the skeletons of fishes to stage-drivers, he fairly 
bubbled over upon the subject. He was fond of the 
meetings of the profession. Since its foundation, the 
New York Surgical Society was his favorite place for 
recounting his experience, and listening to the dis- 
course of distinguished men who organized and main- 
tained its body. 

He was one of the signers of the address to the 
profession of the State against the re-enactment of the 
Old Code, and the movement to sustain the Medical 
Society of the State had his full sympathy and active 
cooperation. 

Social to a degree, he could be found late in the 
afternoon, in the conversation-room or at the monthly 
meetings of his club, with a cigar for himself and his 
neighbor, ready to discourse upon any , subject that 
was uppermost in men's minds. 



JAMES LA WREXCE LITTLE, M.D. 279 

He gave great thought and spared nothing in the 
education of his two sons and a nephew. He had 
almost exaggerated ideas of the importance to a young 
man of an exact and thorough course of study in a 
college. He did not practise his profession with an 
idea of amassing a fortune, but he conceived that it 
was better to thoroughly educate his sons, than to 
leave them the fevv- dollars which a niggardly economy 
might have allowed a physician dying in middle life to 
put aside from his professional income. Before his 
death he had the great satisfaction of seeing his eldest 
son fully equipped and prosperously entered upon the 
practice of a lucrative profession. In his latter years 
he interested himself very much in the study of china 
and bric-a-brac. It became a recreation to him to 
visit auction rooms, and he often came away with a 
rare bit of some kind. 

Galton describes a certain class of men as being in- 
capable of advancing beyond a certain point in mental 
attainment, just as another class can only be developed 
physically to a certain inferior standard. Little was 
not one of these. As long as he lived he grew in 
mental capacity. 

He was never satisfied witli his own preparation 
for the study of medicine ; but while he did not enjoy 
the advantages of a college training that he appreci- 
ated so highly in others, he had that which no con- 
ventional curriculum can of itself furnish — a receptive, 



280 _ J4MES LA WRENCE LITTLE, M.D. 

inquiring, and unbiased mind in science; and so to 
merely scholastic attainments he might have well said 
as did John Hunter, when he heard that he was re- 
proached by a rival with being ignorant of the dead 
languages, " I would endeavor to teach him on the 
dead body that which he never knew in any language 
living or dead." It has been said by one biographer 
of Dr. Little that he was a typical American. It is 
certainly true that his career is a striking example of 
how eminence in our profession may be attained by 
the resources of our own country. His education was 
wholly obtained within his own city. He had none of 
the advantages so useful to the best of men, so with- 
out use to many, which are to be obtained in British 
or Continental schools. But no man more than he 
appreciated the labors of foreign surgeons and pa- 
thologists, no one followed more eagerly the medical 
literature of his time ; but he was fortunate enough 
never to acquire such a slavish esteem for the opinions 
of books that he ceased to think for himself. 

The sense of humor was fully developed in Dr. 
Little. From the busy, and sometimes weary life of 
a general practitioner, and from the society of his 
friends, he extracted much to give zest to his work. 
A joke at his own expense was almost as welcome as 
if at another's. He used to tell with great glee, and 
awakening much laughter as he did so, how a little 
trick of his to stop too prolix patients once got him 



JAMES LAWRENCE LITTLE, M.D. 28 1 

into great trouble. He said that he had found a good 
device for interrupting a needlessly long story on the 
part of a patient was to ask, in the midst of the long 
narrative, " Please let me see your tongue." He found 
that patients bore this interruption very well, and that 
in their eagerness to get the doctor's opinion of this 
index of the digestion, its wagging ceased. But on 
one evening a friend, who was in no sense a patient, 
was making a call upon him, and talked long, when 
Little was very tired. After a time, the doctor's mind 
wandered afar off from the discourse to the discussion 
of medical cases and questions, and, turning to his 
friend, who was in the full tide of talk, he asked with 
great gravity, " Please let me see your tongue." Little 
was never able to explain what happened when his friend 
had fairly taken in the meaning of this interruption. 

But you will demand an end to this desultory con- 
templation of the varied sides of our late associate's 
life and character. A quarter of a century was to be 
the limit of his professional life. In the apparent 
ripeness, not of old age, but of middle life, it was 
ordered that his work should end. As has already 
been intimated, he was actively engaged at a profes- 
sional meeting up to a late hour on Tuesday, March 
31st, and on Saturday, April 4th, 1885, he was in the 
life beyond. In August, 1884, it was discovered that 
he was suffering from diabetes. I believe it is thought, 
by some authorities at least, that the debility induced 



282 JAMES LA WRENCE LITTLE, M.D. 

by this disease, the existence of which was shown by 
the examination after death, made him less able to re- 
sist the acute affection from which he died. At any 
rate it had a sensible effect upon his apparent feelings 
and actions as observed by his intimates. His thirst 
was marked, and he became much fatigued upon slight 
exertion. But he continued his daily work, without 
creating a suspicion of the exisence of any serious 
disease, in those who saw him only at intervals, until 
Wednesday morning, April ist, when he called his 
friend Dr. Lloyd to his office, at about ten o'clock, and 
he found him with his head resting upon his hand, and 
complaining of a severe pain in the right iliac fossa. 

He asked Dr. Lloyd to attend to his clinic for that 
day, while he proposed to make one or two calls in 
the afternoon. He then went upstairs and took a 
dose of medicine prescribed by himself. At noon he 
said he felt better, and he went out to try and finish 
some work; but he soon returned, complaining of 
severe pain. His family physician, Dr. John L. Camp- 
bell, \vas sent for in the evening ; but although the 
most excellent medical advice was sought and obtained 
it was of no avail. When he found himself dying, he took 
his friend and pupil by the hand and said: "Lloyd, 
I am going now;" and a moment later, '' I now realize 
the truth of what poor Beard said." ^ During all this 

^ This refers to the words of the late George M. Beard, in which he 
expressed his regrets that he could not express the thoughts of a dying 



JAMES LA WRENCE LITTLE, M.D. 283 

time he was sufferng Intensely, but his mind Avas en- 
tirely clear, and his spirit undaunted by the fast ap- 
proach of death. He summoned the household serv- 
ants and family about his bedside, and casting anxious 
glances at a clock that was in the chamber, he plainly 
showed that he was counting the moments that he still 
had to live. Having bid farewell to each one by 
name, and with the Avords, " I die in the Christian 
faith " upon his lips, there was a final instant of dis- 
tress, when this brave man yielded up his spirit to the 
God who gave it. 



XL 

THE MEANS OF EFFECTING THE UNITY 
OF THE MEDICAL PROFESSION. 



XI. 



THE MEANS OF EFFECTING THE UNITY 
OF THE MEDICAL PROFESSION. 

Anniversary Discourse delivered before the New York 
Academy of Medicine, Nov. 15, 1888. 

Mr. President, Fellows of the Academy, Ladies 
AND Gentlemen: 
The acceptance of the honor conferred upon me 
by the Council of this Academy, for the second time, 
of preparing and delivering the anniversary discourse, 
brings with it retrospections and reflections that are 
at once tinged with sadness and illumined by cheer. 
Fourteen years ago, when, by your favor, I filled this 
place, a goodly list of honored names, which now is 
sadly broken, was upon our rolls. Austin Flint was 
the President, and besides him there were among the 
fellows Clark, Delafield, Hamilton, Van Buren, the 
Drapers (John William, and John C), Elsberg, Krac- 
kowitzer, Paine, Post, Parker, Peaslee, Marion Sims, 
James R. Wood, Hutchinson, Little, Varick, Agnew, 
Loring, and many others, who have gone over to the 
majority. This array of the departed awakens in our 



288 UNITY OF THE MEDICAL PROFESSION. 

minds the saddest of reflections; but at the same time 
it stirs our loftiest feelings to think that our profession 
made for them an arena of intellectual and moral 
triumph, and that we have been at all worthy to be 
their associates. Although the Academy, with such 
membership, had a high position in medical circles 
throughout the civilized world, and was the medical 
association of the highest rank in our city, it then had 
no hall of its own, and held its meetings in the lower 
lecture-room of the college of Physicians and Sur- 
geons, having just emigrated from the small chapel of 
the University. Its archives and library, whatever 
they were, or wherever deposited, were unknown to 
the average member, and were probably very rarely 
consulted by any one. Funds, except for annual ex- 
penses, the Academy had none, or next to none, al- 
though we were occasionally reminded by the not alto- 
gether social visits of the officers, that they were 
needed. The general professional interest in our work 
was not great, although the President has always been 
chosen from among our most public-spirited and dis- 
tinguished Fellows. The attendance upon the general 
meetings was fairly good, and sometimes crowded. 
The printed Transactions show that the papers were 
usually of a high scientific character. There v/ere 
scarcely any sections; the membership was about one 
hundred and sixty. During these fourteen years we 
have obtained a hall in a house of our own. We have 



UNITY OF THE MEDICAL PROFESSION. 289 

a library of no mean proportions, 30,000 volumes, and 
a reading-room richly supplied with American and 
foreign journals and magazines, while the sections, 
embracing nearly, if not every department of our 
science and art, vie with the general meetings in in- 
terest and attendance, and our membership is now 
nearly six hundred. 

Besides these realizations, we meet to-night in the 
lively hope, thanks to the work of the President and 
Council, that not half the period over which my rem- 
iniscences extend shall have passed away, before 
from an awakened public interest in our profession in 
this city, we shall have rooms and halls in a building 
in some degree adequate to our needs, and somewhat 
proportionate to the professional position of the 
Academy, and to the power in the State which it rep- 
resents. The names and portraits of some of those 
whose combined labors and generosity have brought 
the Academy of Medicine thus far, are upon our walls. 
Many of them are still with us. It is, then, v/ith these 
reflections — those of cheer illuminating those of sad- 
ness, that I begin my discourse, jubilant with hope for 
this representative meeting place of a profession, which 
we may well believe is entering upon a future, whose 
greatness will be to its past, as is an interior to a 
threshold. 

I would speak, so far as it is possible for me to do 
so, in the light of our best traditions and history, and 
19 



290 UNITY OF THE MEDICAL PROFESSION. 

in the spirit of those who, having exhibited in life the 
highest type of their calling, have left behind them a 
durable impression upon our time. To continue their 
work in their aspirations, and to its legitimate ending, 
in greater power, is certainly the aim of the Fellows of 
this Academy. That they desired a united catholic 
profession, with one faith and a common altar, is be- 
yond all question. The Latin motto over the execu- 
tive chair indicates these aspirations. 

If our profession were a united one, without sects 
in it, we should then be like the profession of law, 
whose members, however they may differ in opinions, 
ability or experience, have no qualifying or distin- 
guishing prefix to indicate their mode of practice. 
There is no good reason that I can conceive of, why 
this condition of things should not obtain in medicine, 
and a member of this profession be simply a physician 
or a surgeon. But how far are we from this ideal ! In 
this State, we have three distinct classes of physicians, 
besides a host of unclassified irregulars, not yet recog- 
nized by the Legislature, but having a more or less 
considerable influence upon the community. Such a 
condition is one far removed from unity, and yet the 
world admits that there is a force in union, that no 
individual energy can supply. A profession which 
comes in such intimate and vital relations to the wel- 
fare of the human race, as does ours, should not be 



UNITY OF THE MEDICAL PROFESSION. 29 1 

divided into conflicting parties, for there is but one 
science of medicine. 

I think a Httle reflection will convince even those 
who may not as yet have given the subject any consid- 
eration, that the medical profession of this country 
does not, as a body, as an organization, or as a number 
of organizations — for the latter it really is — hold quite 
the same rank; does not have quite the same authori- 
tative influence upon the public at large, as does the 
church, the law, or the press. From a certain point of 
view this may not at first seem correct. In what may 
be called private or personal relations no man is more 
potent than the physician. The family physician may 
well, and to his ovrn advantage, compare his influence 
over his patients with that of the clergyman over his 
flock, the lawyer upon his clients, or the press upon its 
readers. Whether in the great city, in the gorgeous 
chamber of the rich, the top floor of the tenement 
house, or the wards of the hospital, or in the isolated 
dwelling of the prairie, the backw^oods, or the moun- 
tain settlement, when with the suffering patient, even 
a look of the physician is almost omnipotent. No one 
may challenge his claim to headship there. Except 
that of a mother to her child, or a husband to the wife, 
there is no more powerful bond than this. But this, 
as I have indicated, is a personal and individual rela- 
tion. It has nothing to do with the position of the 
medical profession as a body. 



292 UNITY OF THE MEDICAL PROFESSION. 

The day has gone, when the physician is to be re- 
garded solely in this isolated relation, responsible and 
exalted as it may be. Not only has the specialist 
come, who, among the other asperities of his pathway, 
endures the consciousness that he has only a temporary 
acquaintance with his patient, which forbids the idea 
of any such confidence as that which is given to the 
family physician ; but there is also the expert hygienist, 
who labors in boards and corporations for the preven- 
tion of epidemics and for their repression when they 
have arisen ; the scientist in his laboratory, working at 
the great problem of the cause of disease; the medi- 
cal chemist, the journalist, the teacher of anatomy and 
physiology, in fact, the great divisions of specialists, 
yet all members of the medical profession quite as 
much as the general practitioner. Thus the exigencies 
of the nineteenth century, with its telegraph, its rail- 
way, its phonograph and telephone, have divided 
this great profession, which, not so long time ago in 
England was only to be found in the apothecary and 
the barber-surgeons. My thesis naturally flows from 
these facts. We have been passing through a stage 
of disintegration, about which many have been unduly 
anxious, and many others witty, with their jibes at the 
allotment of the body in its various parts to the difTer- 
ent specialists. There have been fears that the family 
practitioner had departed, never again to be a house- 
hold god. Medical specialists have been even likened 



UNITY OF THE MEDICAL PROFESSION. 293 

to the gunmakers of Springfield, one of whom could 
make the hammer, another the barrel, while none of 
them was capable of producing the complete weapon. 

As has often been clearly shown, specialism in 
medicine has never thus divided the profession into in- 
capable component parts. The best specialists have 
always been made of the best general practitioners, 
and a good general practitioner has always been able 
to detect a danger which he may have felt necessary 
to ask a more experienced hand to avert. Each pro- 
fession must take its turn in being a butt for ridicule. 
The modern Molieres have not spared the modern 
doctors, and they have accused us of parcelling out 
the human body to different mechanics for examina- 
tion and treatment. Yet we must admit, that just as 
society in the nineteenth century has not yet caught 
up with many of the changes induced by steam and 
electricity, and finds some of them inconveniences 
rather than blessings, in the same way the medical 
profession has not yet adapted itself to the apparent 
divisions in the activities of its members. The point 
of complete fusion has not been reached. We are the 
parts of a dissected map, not again put together, 
although a wise eye can detect our real unity. The 
times have not yet been ripe for the complete adjust- 
ment of the relations of specialism to general medicine, 
but they are fast becoming so, and we may safely 
leave that part of our former discords to the healing 



294 UNITY OF THE MEDICAL PROFESSION. 

influences of passing years. They are rapidly smooth- 
ing out all the inequalities in those relations. 

It is of unity of a higher, or rather of a broader, 
character than that between specialism and general 
medicine that I would now speak. It is of a unity 
once existing but now lost, which allows all those who 
in any way by their work in life, either in studying the 
structure of the human frame, or the causation and 
nature of disease, are contributing to the miitigation 
or cure of physical suffering, to unite as members of 
the medical profession under the common name of 
physicians. In discussing the means for securing this 
unity, I shall consider only this State of New York. 
In studying its medical history and reasoning from it, 
I think we may find ample ground for the subject of 
this evening. 

Although we may justly complain that we do not 
now possess the power that comes from union, and 
that we are thus made inferior to the profession in 
other countries, there is one advantage that we enjoy 
in America. Social position, the American doctor 
may have. If he does not, it is clearly a fault of his 
own, for our American system confers no degrees of 
nobility except such as are the spontaneous gift of the 
people. The exceptions to this rule are not numerous. 
Sometimes great riches give undue and unmerited 
prominence in society; but even in this case, unless 
the money is honestly earned or worthily inherited, 



UNITY OF THE MEDICAL PROFESSION. 295 

and used with liberality and friendliness to those less 
fortunate, riches confer no permanent prominence in 
any respectable circle in this country. The American 
doctor, like any other Am.erican citizen, however 
humble his origin, may enter any circle, where his 
abilities and character give him the right, as an equal. 
The situation in some other countries is painfully 
different, and notably so in England, which in so many 
respects represents the highest type of our civilization, 
and yet where sometimes the stamp of the guinea is 
not on pure gold. A younger son of an English peer 
became enamored of medicine, and pursuing his studies 
obtained a qualification to practise. His family insisted 
that he must not practise in England, on the ground 
that an occupation of that kind was beneath his rank; 
but they consented that he should pursue his profes- 
sion in a neighboring capital. Successful there, he 
enjoyed a large practice. But it was observed that his 
assistant always attended the family of his country's 
legation, and that he never personally prescribed for 
any of them. He himself gave as a reason for this, to 
an American medical friend, that were he to do so he 
would so lower his social position that he could not be 
invited to dine with his exalted countrymen. Were it 
necessary, incidents, known to many of us, could be 
told to corrobate the truth of this particular narration, 
and which would illustrate the correctness of this view 
of the social position of a Doctor in Medicine in Eng- 



296 UNITY OF THE MEDICAL PROFESSION. 

land. Many of us have heard a distinguished English 
surgeon express his surprise at the high position taken 
by American physicians in the society of their own 
country. It is certainly true that a practitioner of 
medicine in England, unless under exceptional circum- 
stances, when the disability is in part removed by 
knighthood, does not rank as what they are pleased to 
call a gentleman. He even ranks below the lawyers, 
and meekly takes up the position assigned to him, and 
like the rest of the commonalty of that country, dearly 
loves a lord. Yet the position of the profession in 
England, on a scientific basis, is one of the most honored 
in the world. Many believe that, on the whole, it 
best represents the rank of our profession in the world, 
both by the reputation of its present members for 
scientific attainment and by its illustrious history. 

My object in this allusion is simply to show that 
there exists no obstacle in our country that can pre- 
vent us from securing any position as a body, that our 
merits will justify. There are no lines of caste here, 
that prevent us from obtaining all our rights and priv- 
ileges as a learned and philanthropic body. But as 
things are now, it becomes evident upon the most 
casual observation, and it has been repeatedly shown, 
that the medical profession as a body has no sufficient 
power or influence in many matters which should be 
absolutely under their control as in war are campaigns, 
once entered upon, under the direction of the com- 



UNITY OF THE MEDICAL PROFESSION. 297 

manding general. Only experts run engines by land 
or by sea. Bank presidents are not made of men un- 
learned in finance. Only scholars are professors of 
Latin or Greek. And yet private and public sanitary 
affairs, the prevention of epidemics, the government 
of hospitals, are very often directed, in whole or in 
part, by men of very good business, military, or me- 
chanical training, but with no knowledge of medical 
matters, but sometimes with professed skill in dealing 
with a recalcitrant and impracticable medical man. 
Boards of Education, Boards of Health, sanitary legis- 
lation, are often conducted with but a feeble represen- 
tation of medical men. W^hen a doctor is appointed 
to a strictly medical position, requiring the highest 
type of medical learning and skill and experience, it is 
often because he is a man of attainments of a high 
order in petty politics, while his medical qualities are 
correspondingly low. This condition of things obtains 
because the people as a whole actually believe that the 
profession, as a profession, knovv^s but little, if any more, 
about general sanitary matters or medical legislation 
than does a level-headed and successful banker, or rail- 
road man, or a scientific plumber. We are divided into 
so many parties, each crying its shibboleth, that the 
public at large have at last come to think that however 
skilled a doctor may be in the management of a sick 
person or the direction of affairs in a house threatened 
or invaded by disease, he needs a good deal of lay over- 



298 UNITY OF THE MEDICAL PROFESSION. 

sight and repression,when he assists in the management 
of matters pertaining to public hygiene or health. 
Fortunately the United States Army and Navy have 
been trained to think differently; no such opinions are 
held there. 

For this state of things, I, for one, have no fault to 
find with the sovereign people. Neither am I bring- 
ing any accusation against the press of our country, a 
power that does so much in leading public opinion. It 
is generally on our side in any matter where we repre- 
sent the best interests of the country. The blame 
should fall in part upon the rapidly changing condi- 
tion of things in our country, and in part upon our- 
selves. The fact is, that we have for some years de- 
manded very little more of the State, than that we 
should be let alone. We have not until lately asked 
to have our laboratories or colleges endowed, even by 
individuals. We have assumed that our colleges are 
private institutions, in which no one but the students 
who attended them, and the professors who owned 
them, were at all interested. More than all, we have 
acquiesced in the taking away from us of privileges 
which formerly were conceded to us. 

This brings me to the kernel of what I have to say. 
Our lack of unity depends not upon any want of social 
position, nor upon the estimate of us that the public 
have voluntarily assumed, but upon one that our own 
bickerings and quarrels have forced them to take. For 



UNITY OF THE MEDICAL PROFESSION. 299 

many years the profession in this State has been prac- 
tically detached from the governing power. It has 
submitted to this, and instead of forming a part of the 
political commonwealth, it has chosen another way, 
one which has produced, and is producing, a pernicious 
state of things, harmful not only to the unity and honor 
of the profession, which this Academy represents, but 
what is far more important, to the community whom 
it serves. 

When this century was young, the medical profes- 
sion of this State was a united one. It was every- 
where recognized as such. A doctor was a doctor, 
without any further definition. The first college that 
we had, the College of Physicians and Surgeons, was 
under the direction of the Regents of the University, 
and the members of the County Medical Society were 
its trustees. The idea had not then entered the mind 
of the medical prefession that a medical college should 
be responsible only to its faculty, or that there could 
be three or four varieties of Doctors of Medicine. 
Until Samuel Thomson brought his botanic medicines, 
his steam and herb doctors from New England, there 
were but two kinds of doctors in New York — gradu- 
ates of medical schools and licentiates, and they were 
allowed to practise only after a rigid examination."^ 

For nearly twenty years v/ar was waged between 

* The Status of the Medical Profession. By H. G. Piffard, M. D. 
D. Appleton & Co., 1884. 



300 UNITY OF THE MEDICAL PROFESSION. 

these graduates and licentiates, and Thomson's ad- 
herents, men of no strictly medical education, until, in 
1827, the Legislature granted rights and privileges to 
the profession which, had it been tolerant and wise, we 
should have held until this day. To the State Medi- 
cal Society was given the power, and the sole power, 
of regulating the standing of the profession in the 
State. The State Medical Society was a part of the 
legal organization that made up the State. Such a 
condition gave an excellent tone to the medical pro- 
fession. It is true that medical science, as a science, 
had no such exalted position as it has now. The 
achievements which have produced anaesthesia, the 
thermometer, antiseptic surgery, and the various in- 
struments to facilitate a thorough examination of dis- 
eased and healthy parts, were in the future ; the bacteri- 
ological studies, now so full of promise, were unknown ; 
medicine was given in cumbersome and distasteful 
forms; too little attention was paid to the natural 
course of disease ; but we had men with great minds and 
with the tactus eruditiis. We had a Romeyn, a Mitchill, 
a Mott, a Hosack, a Francis, and others who had set 
their stamp upon their day. The medical profession 
then kept step with the other professions and with the 
time in general influence, and its character as a body, 
it seems to me, as well as history and tradition tell it, 
was, if anything, higher, certainly as high as now. But 
not content with its high position as recognized by the 



UNITY OF THE MEDICAL PROFESSIGX. 3OI 

political power of the commonwealth, the medical pro- 
fession undertook to repress opinion and practice as to 
the treatment of diseases. The heresy was not as to 
the ascertained facts in anatomy or physiology; it was 
not a question as to how the human body was consti 
tuted, as to what was the structure of the heart and 
liver, but as to what drugs were to be given in cases 
of ascertained disease, and as to what was the principle 
upon which they acted — heresy, in short, on subjects, 
however it may have been fifty years ago, in which 
there is no orthodoxy now. These new heretics were 
not like the Thomsonians, uneducated men, but trained 
in the same schools with other members of the pro- 
fession, in good and regular standing in the County 
Societies, and under the protection of the law. 

In 1842, in the pasturages of Orange County, the 
fight waxed so warm, that the County Society forbade 
a homoeopathic physician from practising within its 
jurisdiction. This fatal step caused the persecuted 
sect to appeal to the Legislature, which not only de- 
prived the County Societies from preventing those to 
whom they objected from practising, but also allowed 
anybody to practise who chose to call himself a doc- 
tor. This, to the whole profession and the community, 
was the opening of Pandora's box. Let it be granted 
that the theories of the heretics were absurd and their 
remedies at the most innocuous, what have become of 
many of the theories and some of the remedies of our 



302 UNITY OF THE MEDICAL PROFESSION. 

orthodox ancestors ? The principle at the base of 
some of them and many of the remedies remain; 
enough, I think, to substantiate our claim to be the 
regulars, even if we are old school; but it has been 
demonstrated that much that we thought of the 
greatest importance was not so, after all, and that if 
we had allowed smiilia similibus curantur and the doc- 
trine that the potency of drugs is increased with their 
attenuation, and that of the sole efficacy of vegetable 
medicines, and the vaunted virtues of cold water, to 
have the full swing, no one would have been the worse. 
— No one is harmed now, when the wildest theories 
and the most remarkable claims for medicines are ad- 
vanced in the most sacred precincts of regular and old- 
school medicine, with no other punishment than merci- 
Ijess and destructive criticism. 

Heresy-hunting is sometimes successful, but when 
the regular medical profession of the State of New 
York undertook the work of exterminating the fol- 
lowers of Hahnemann, they probably had little idea of 
what was before them. With the fervor of Puritans, 
and the chivalry of Cavaliers, our medical ancestors pro- 
ceeded to cast out men educated in the same medical 
schools with themselves; men whose technical qualifi- 
cations, whatever future generations may think of their 
judgment and their common-sense, were obtained at the 
same sources, and were presumably of the same quality 
as that of their persecutors. Their discontent with 



UNITY OF THE MEDICAL PROFESSION. 303 

some of the prevailing harsh and routine methods of 
treatment of their time, had led them to adopt the 
fantastical ideas of a theorist. They were sometimes 
violent and severe in their denunciations of the men 
who still walked in the old paths. It is no wonder that 
they were driven out. But expulsion was an unsuc- 
cessful way of dealing with them, unless it was desired 
to give them free scope and extended power. 

The men who were expelled, not on account of 
the quality of their education, but because they flouted 
the old systems and advocated what the regulars 
deemed a fantastical one, appealed to the State. The 
State recognized them. A new Medical Society was 
formed. Then the Thomsonians, or Eclectics, as they 
choose to be called, took advantage of the amnesty 
now proclaimed by the Legislature for all irregulars. 
The deed was done. The once united profession, with 
ample provision for securing at least educated men for 
its practice, was now divided, and divided it remains 
to this day, with no standard as to what constitutes a 
Doctor in Medicine, except a very low and fickle one 
adapted to the requirements of the three State medi- 
cal societies and the ten medical colleges of the State. 

The medical colleges of the new schools vv^ere by 
no means as particular as to the qualifications of their 
graduates as were the old and regular ones, but their 
degree, in the eye of the law, became just as valuable. 
It conferred the same license to practise medicine. 



304 UNITY GF THE MEDICAL PROFESSION. 

This of itself caused a great deterioration in the quality 
of the profession. Many of the successors of the orig- 
inal homoeopathic practitioners were by no means as 
well educated as were the originals, while as to the 
standard among the eclectics the least said the better. 
All this produced incalculable harm. The State had 
stepped in to actually lessen the requirements neces- 
sary to constitute a Doctor in Medicine. 

It is now easy to see that no harm would have 
come from little pills, or vegetable remedies, or cold 
water, if absurd or heretical opinions had been treated 
as they are now treated, while the educational require- 
ments for admission to the right to practise had been 
rigorously maintained. To insist upon attainments in 
the exact knowledge of the structure and functions of 
the human body in health and disease, together with 
ability to operate upon it in a skilful manner, is to 
remove all the danger that it is possible to remove 
from allowing men to care for the sick. But as a fruit 
of this crusade against heretical opinions anyone who 
can get a degree from a rigid or a lax medical school, 
or who can get a diploma which he has brought from 
some other county or State, endorsed by a college 
here, is allowed to practise medicine. In the earlier 
days we had censors chosen by the profession, who 
controlled the examination, and there was at least one 
standard .^.ade by independent men. These censors 
acted through the County Societies or the three or 



UNITY OF THE MEDICAL PROFESSION. 305 

four medical colleges of the State. To this system, 
but with much larger liberty of opinion, with absolute 
freedom of action in therapeutics and theories of the 
action of remedies, we must return. The State must 
concern itself, through its properly chosen agents, to 
know that those who are licensed to practise medicine 
shall know both the structure and action of the differ- 
ent parts of the hum.an body, the methods for saving 
life and restoring functions by surgical operations, 
and the antidotes for active poisons. It must ascer- 
tain that those whom they allow to prescribe for the 
sick have availed themselves of opportunities for study- 
ing disease. Beyond this, the State may certainly 
allow complete freedom. 

There are those who look forward to a day when 
the standard shall be much higher than this. They lay 
great stress upon what is called an academic education, 
such as is indicated by having a degree of Bachelor of 
Arts from an American college. With this view I have 
no sympathy. Whether or not the college course of our 
country needs great modification for those who study 
theology or law, or who become journalists, may be 
an open question. But the present system, even when 
modified by elective courses, is not fitted for future 
doctors in medicine. It is a great waste of time, in 
my opinion, to cause a young man who proposes to 
study medicine, to spend four years in an undergradu- 
ate college, in the studies in which the ordinary college 



306 UNITY OF THE MEDICAL PROFESSION. 

student is engaged. Two years, bringing the student 
up to the junior year, are important and sufficient for 
him. Then his university life should begin. Some 
day, our colleges, instead of expanding into so-called 
universities, will take what are only apparently back- 
ward steps, and become colleges, and let their young 
men out with two years less of Greek and Latin and 
then send them to real universities. The Alumni and 
Professors of undergraduate colleges are still as a body 
unprepared to accept this view. They consider those 
who hold it as enemies of sound learning. But, finally, 
President Barnard will have many followers. Our 
small colleges will become like the German Gymnasia 
and carry a student through the essential part of a 
classical training and mathematics, while the great 
colleges like Columbia, Princeton, Yale, and Harvard 
will be universities, where young men may enter 
directly upon professional and post-graduate studies. 
Students now enter our colleges too late and stay too 
long, if the profession of medicine is their goal. Until 
these reforms are brought about, those who wish to 
study medicine should either enter scientific schools 
as soon as their preparatory studies are over, or leave 
the colleges as now constituted at the end of the 
second year. But this is an incidental subject, for the 
introduction of which I almost beg your pardon. 

There are still those, however, in our profession 
who make uniformity of opinion on matters of drugs, 



UNITY OF THE MEDICAL PROFESSION. 307 

their doses, their uses, and the principles upon which 
they act, a very serious matter. For example, at a 
meeting of a regular State Medical Society, during the 
heated term, a member read a paper in which he ad- 
vised that '' every homoeopath should be hung till he 
was dead three times." 

I once heard a zealous French Republican remark 
that France would only become a Republic, when 
every Orleanist, every follower of Henry V., and 
every Bonapartist, to the remotest branch of the 
various pretenders, were gathered in one place and 
blown up with dynamite. I admit that this is the 
true method, if we really wish to effectually stamp 
out heresy and obstinate public opinion. The his- 
tory of the world shows that while banishment has 
generally, if not always, proved to be ineffectual, uni- 
versal killing has been found a successful method in 
some countries of dealing with heretics and their opin- 
ions. But we must be sure to kill them all, and not 
leave any for the propagation of a future race. As 
we can hardly expect the State, with its present ideas, 
to adopt this view of its duties of regulating the prac- 
tice of medicine, we are compelled to seek some other 
method of securing unity in the profession. Then, 
again, we find it more difficult than did our fathers to 
determine where heresy begins. Shall we say that 
a medical man is unfit for professional association 
because he brings ^himself to believe that scarlatina 



308 UNITY OF THE MEDICAL PROFESSION. 

can be checked by infinitesimal does of belladonna or 
that quinine or antipyrine will cut off typhoid fever, 
or that electricity will cure cataract, or sulphide of 
calcium will abort inflammation, any one of which 
opinions is resolutely held by well-educated and ex- 
perienced men, and as firmly denied by others. It is 
impossible to deal seriously with those who would 
drive out men from a learned profession, not because 
their attainments are insufficient, or their moral char- 
acter defective, but because they are believed to hold 
erroneous notions in the materia medica and in thera- 
peutics. As Schiller says : Mit der Dummheit ist nicht 
zu kdmpfen. We must leave our honest but blood- 
thirsty friends, v/ith their beliefs as to the true way of 
dealing with error, to their ultimate correction when 
they finally learn that not all of wisdom shall die with 
us, even if we are the people. Their intolerant 
notions will ultimately repose in the same limbo with 
those of the hobbyists, with their panaceas for the in- 
curable, and their exact knowledge on things in which 
there can as yet be no exactitude — a limbo crammed 
with the humbug of ages. 

It ought to be said, however, in extenuation of the 
want of wisdom of our revered fathers in this matter, 
that they verily believed they were doing God service, 
as much as Paul, when he was haling men and women 
and bringing them bound to Jerusalem, because they 
accepted the doctrines of the Narazene. The ani- 



UNITY OF THE MEDICAL PROFESSION. 309 

mosities of our profession have passed into the proverbs 
of the language. A recent EngHsh critic says that 
he has known excellent men " grow white with rage in 
defence of vivisection," and he explains that ^' doctors 
are peculiarly liable to this kind of fury, because they 
are protecting human life, and feel that a mere blunder 
in theory may involve a sort of murder, and that, too, 
on a large scale." "^ 

But what is the remedy for the present disunited 
condition of our profession in this State ? This remedy 
is to be found in making — not a common standard for 
the degree of Doctor in Medicine, but a common stand- 
ard for the license to practise medicine. That should 
be conferred, as now, by each college according to its 
own ideas as to what constitutes a sufficient education 
for the honor. But the liberty to practise medicine 
should not longer be left in the hands of bodies, how- 
ever respectable and however distinguished, who are 
actually only responsible to themselves. During the 
past few years, after a most thorough discussion, car- 
ried through several sessions, the principle of this 
statement has twice in succession been unanimously 
approved by the oldest Medical Society of this State. 
The last President of this Society, Dr. Loomis, in his 
inaugural address advised the Committee on Legisla- 
tion to urge the passage of a law for a State Board of 
Examiners, on the late Legislature, and if unsuccess- 
* The Spectator, London, October 20, 1888. 



3IO UNITY OF THE MEDICAL PROFESSION. 

ful, upon succeeding Legislatures '' until it shall be- 
come law of the State." Only lately the member of 
the bar, who of all others has given by far the most 
attention to medical legislation, has announced him- 
self* in an address as an advocate of such an Examin- 
ing Board. There is only a single authority on medi- 
cal education in our State who, so far as I know, 
openly opposes such a law. Dr. Austin Flint says on 
this subject: '' State medical boards, appointed to de- 
terminate by actual examination the qualifications of 
applicants for license to practise medicine, can never 
be of any great practical benefit so long as it is deemed 
necessary to recognize in their organization certain so- 
called systems of practice, such as homoeopathy and 
electicism."f 

There are homoeopaths and electics in Canada, in 
Illinois, and in Virginia and Alabama, where such a 
system as the State Society of New York advocates 
is in full action, and yet no practical difificulty, but the 
greatest benefit, has been found in the operation of 
the law. There is no longer any opposition to the 
system on the part of our profession in our State, but 
the proposed law gets no further in the Legislature 
than to be sent to a committee, when a dispute occurs 
to the ratio of representations on this proposed board, 
or some other minor point. This discussion gives our 

* W. A. Purrington. 

t College and Clinical Record, vol. ix., May and June, 1888. 



UNITY OF THE MEDICAL PROFESSION. 31I 

law-makers an opportunity, of which they are not slow 
to avail themselves, to lay the whole subject on the 
table until the doctors can agree. 

In the course of some remarks upon this subject in 
the State Society some years ago, the President of this 
Academy predicted that the people themselves would 
some day demand the establishment of such a system, 
and then we should have it. It is with a view of in- 
forming some of the influential and conscientious 
members of the community in this State, as to the 
needs of the profession and through them the public, 
on this subject, that this discourse has been written. 
Not many years since the people demanded that the 
privilege of entering the legal profession directly from 
a law school, without an examination by the courts, 
should be abolished. The law-schools of the State are 
only two in number ; they are irreproachable in repu- 
tation, and no glaring, perhaps no improprieties at all, 
existed in their management. But the legal profes- 
sion, and through them the public at large, grew jeal- 
ous of any liberty to enter the profession other than 
that granted by an examination by an independent 
board constituted by the court. This kind of an ex- 
amination the professors of a law-school, however ably 
conducted, however endowed by individuals or cor- 
porations, could not furnish. As I have already said, 
in the State of New York if a man or woman receive 
a degree of Doctor in Medicine in one of the regular 



312 UNITY OF THE MEDICAL PROFESSION. 

chartered medical colleges of the State, he or she may 
practise medicine here without further leave or license. 
Those who come from other countries and other States 
must have a diploma from some regularly chartered 
college, and this must be endorsed by one of the col- 
leges of this State. The number of men who acquired 
the right to practise medicine as they may, by passing 
the examination of the Regents of the University and 
by license from the censors of County Medical Societies 
is so small, that they may be left entirely out of con- 
sideration. 

It is thus seen that the colleges, and one college 
equally with another, has the powder of determining 
who shall practise medicine. The standard of attain- 
ment required by these various colleges, in this State 
varies exceedingly. Not one of them, moreover, sep- 
arates the matter of granting degrees entirely from the 
instruction. With this I have no quarrel. Those who 
have instructed the men are, on the whole, altogether 
the most suitable persons to determine their qualifica- 
tions for a degree. But after they have determined 
this to their satisfaction, and conferred the degree, the 
State should step in and say, '* in behalf of the people, 
we will now decide whether the possession of this de- 
gree gives you the general knowledge required by the 
standard which the State thinks requisite for a license 
to practise. If the army and navy, if the hospitals 
will not accept the fact of the possession of a degree as 



UNITY OF THE MEDICAL PROFESSION. 313 

sufficient, neither will we." Certainly the physical 
welfare of the men and women and children of the 
State requires as much supervision and solicitude as 
the soldiers and sailors and the inmates of hospitals. 
These medical colleges of this State, as everybody 
knows, are, for the greater part, of the most respect- 
able kind. The education that may be obtained in 
them is of the highest quality. The ablest men in the 
profession are in the faculties. Until within a few 
years an excessively large proportion of the scientific 
work of the profession, work that is always of ultimate 
value to the patient, was done by the professors and 
instructors in these institutions. The well-substanti- 
ated renown of American medicine, a renown that 
causes its literature to be translated into every civilized 
tongue, and its great workers to be everywhere recog- 
nized, is chiefly to be ascribed to these colleges. Even 
now, when professional activity is much more widely 
diffused and better organized outside of the colleges 
that grant the degree of M.D. than ever before, these 
institutions continue to do their work as well or better 
than ever; and yet but very few large hospitals will 
give one of their graduates an opportunity to practise 
in them, even in a subordinate way, without first sub- 
jecting him to a more or less rigorous examination, 
conducted by the medical officers of the hospitals. I 
have known one instance, at least, where three candi- 
dates for one vacancy were rejected, and the hospital 



314 UNITY OF THE MEDICAL PROFESSION. 

sent out for other candidates to come before them. 
Not one of these young graduates is allowed to prac- 
tise among the soldiers of the United States Army, or 
the sailors of the United States Navy, until he has 
passed another examination by their medical officers; 
and, as a matter of fact, a large proportion of those 
who attempt to pass this latter examination are found 
incapable.* 

Yet the State of New York gives this Doctor in 
Medicine the right to practise without further question. 
It says, by inference, ''Although many of you are not 
qualified to enter a civil hospital, and treat the patients 
there, even when your work is carefully supervised by 
men of experience ; although very many of you are not 
fit to have the care of sick or wounded soldiers or sail- 
ors, yet all of you, wherever you can find an oppor- 
tunity in our borders, may engage in private practice 
without any independent supervision." It is willingly 
conceded that in some departments of medical practice 
no such high grade of qualification is required as should 
be among the picked medical officers of the army or 
navy. But investigation shows that these graduates 
of medical colleges are not rejected by Army and Navy 
Medical Boards because they are deficient in the 
highest departments and the non-essentials of medical 
knowledge, but because they do not know the antidotes 

* During- a time of peace, however, the best men of the colleges do 
ot generally compete in these examinations. 



U.VITV OF THE MEDICAL PROFESSIOX. 315 

for poisons, because they do not know how to set a 
broken arm or leg, how to tie an artery or dress a 
wound, how to rescue a person from drowning, above 
all how to recognize a common disease. Certainly the 
State should restrain mad dogs from running at large, 
and regulate the storage of gunpowder. The State 
may certainly not concern itself to know whether a 
doctor knows the French language or the fundamentals 
of geology; but it should know whether a licensed 
practitioner can really practise whatever would be 
everywhere conceded as the essentials of his art. 

Such a board would not create a revolution. But 
it would do something to protect the community from 
the dangers of ignorance in the essentials of the prac- 
tice of medicine on the part of those who assume to 
take care of their health. As things are now, the most 
of those who receive the degree of M.D. w^ould easily 
pass the State examination. But a dangerous few 
would be thrown out. Such a system once estab- 
lished, and sects in medicine would soon be practically 
destroyed. There would be a common standard of 
fitness based upon a knowledge of the structure of the 
body and the recognition of disease. Differences in 
the modes of treatment might safely be left to them- 
selves, were we once assured that all practitioners were 
qualified in essentials. One of the medical orators and 
a Vice-President of this Academy, at the opening of the 
new College of Physicians and Surgeons lately, said : 



3l6 UNITY OF THE MEDICAL PROFESSION. 

" It is a melancholy but indubitable fact, that the standard of medical 
education in this country is far below that of England and the Continent 
of Europe." * 

I do not believe that this lowering of the standard 
of what may be called the general average of medical 
attainment in this country is due to the fact that many 
of our Doctors, more than half of them, are not 
Alumni of undergraduate colleges, and are deficient 
in Latin and Greek, but because many of the medical 
colleges have not sufficiently instructed them in an- 
atomy and physiology, in medicine and surgery, and 
good habits of observation. It is not so much in the 
preliminary as in the professional training that great 
deficiencies have occurred. The terms have been too 
short, and in many instances the degrees have been 
too readily granted. I am not aware of a civilized 
country but our own, where irresponsible medical 
schools are allowed to determine the right to practise 
medicine. It is due to this condition of things that the 
qualification of the average doctor in medicine abroad 
is higher than ours. 

When a medical congress meets in Amsterdam or 
Copenhagen or Brussels, there is no difficulty in the 
enrollment of physicians. If a man has a qualification, 
he is enrolled. But when one meets in Philadelphia 
or Washington, how different. A great many things 
must be inquired into, until assurance is had that the 
degree represents what it assumes to. Where is the 

* W. H. Draper. 



UNITY OF THE MEDICAL PROFESSION. 317 

college that grants it ? How long is its course ? Are its 
candidates properly examined ? In short, to say that 
a man possesses a degree from a regularly incorpo- 
rated college in this country, by no means determines 
that he is deemed a fit associate in a learned. body de- 
voted to the consideration of medical subjects. It is 
true that considerations as to the belief in so-called 
dogmas are sometimes made grounds for exclusion 
here ; but the fact remains, that the American standard 
of essential knowledge is far from being uniform, and 
is generally too low, and that for this reason much 
more and closer scrutiny of what is technically called 
a medical qualification, must be made here than in a 
European State. It conveys no such assurance, when 
found in the hands of a medical man in this country as 
it does abroad, that we are dealing with a reasonably 
well-informed doctor in medicine. Now that it has 
been practically settled by the voice of the profession 
that they desire the protection of the community by a 
change in our laws — such a change as will cause all 
who in future desire to practise medicine in our State 
to pass a common examination and come up to a com- 
mon standard — I have taken the opportunity afforded 
me by the invitation to this discourse, which is, by a 
by-law of the Society, devoted to the laity as well as 
to my brethren, to attempt to influence the public at 
large, to unite with us in securing a law constituting 
a Board of Examiners for the license to practise medi- 



3l8 UNITY OF THE MEDICAL PROFESSION. 

cine. I believe, with our President, that without your 
sympathetic and active co-operation the accompHsh- 
ments of such a reform will be impossible. But when 
you see your way clear to demand it of our legislators, 
they will comply, and that speedily. 

Such a law will in time effect the unity of the medi- 
cal profession and greatly increase its beneficent power. 
This latter effect is certainly desired by every citizen. 
If it can be demonstrated to you that under a new 
system of admission to the practise of medicine, in- 
creased confidence in the average medical adviser will 
arise, and that you will be actually safer in limb and 
health, no further argument will be needed. To those 
who believe in gifts of healing in the nineteenth cen- 
tury, and in the power of the seventh son of the seventh 
son, and to the devotees of the faith and mind cure, 
no argument can be effectual. But to those who be- 
lieve that the possession of a certain number of the 
facts in what is called medicine, is a necessary pre- 
requisite to a right to practise ; that a man should know 
the anatomy of the human stomach for example, be- 
fore he puts drugs in it, the situation of a blood-vessel 
before he tries to tie it, that he shall be able to distin- 
guish pneumonia from peritonitis; I confidently appeal 
for a law that shall allow no one to practise until a 
proper and independent authority has determined that 
such facts have been learned by the candidate. 

As I have intimated, as a minor but not unimpor- 



UNITY OF THE MEDICAL PROFESSION. 319 

tant consideration, such a law will break up the odious 
scandal that has so long been so abhorrent to many 
outside of our profession, of so-called different schools 
in the treatment and care of the sick, standing apart 
from each other, or retreating in the face of a common 
enemy. Let us educate all medical men up to a com- 
mon standard, and then all difficulties in the way of 
relations wdth each other over the patient will vanish. 
This proposed law will also cause a more general in- 
terest in seeing that the proper facilities for the study 
of medicine are amply furnished. Our colleges, our 
laboratories, our centres of instruction will become not 
isolated, but general objects for private benevolence 
and philanthropy. There is really no subject in which 
the community at large has a more vital interest than 
the quality of its medical men. Except an occasional 
railer at our impotence, who mourns what we cannot 
compass the infinite and cause men and women to 
avoid the awful but irrevocable truth, '' Whatsoever a 
man soweth, that shall he also reap ;" everyone realizes, 
that physicians are important as individuals to the 
general public, but it is for our recognition as a great 
factor in the various parts that make up the edifice 
that we call the State, that I plead. Through such a 
recognition with its accompanying supervision, al- 
though not in the absolute and paternal way of unre- 
publican, or, rather, of unconstitutionally governed 



320 UNITY OF THE MEDICAL PROFESSION. 

countries, your safety and care as individuals will be 
better assured. 

In one of the first months of the War of the Great 
Rebellion, a squadron of United States cavalry was 
galloping at night through the lanes of Northern Vir- 
ginia. A young medical officer rode beside the captain. 
Suddenly, as evidence of a hostile force in ambush 
reached the trained eye or ear of the officer in com- 
mand, a man of long experience among the Indians of 
the frontier, there came the order '' Halt ! " After 
some hurried directions to the orderly sergeant, he 
concluded, '' Put the doctor in the centre; we may 
need him." So I ask you, while the physician shares 
with you the perils and vicissitudes of life, care for him 
and his class, put him in the centre, safe from needless 
injury and unwarranted peril, and where he may, to 
his capacity and in the proper time, help to maintain 
and preserve the commonwealth. 



